MR SPEAKER'S ABSENCE

The House being met, the Clerk at the Table informed the House of the absence of Mr. Speaker from this day's sitting, pursuant to leave given [18 January].
	Whereupon, Sir Alan Haselhurst, the Chairman of Ways and Means, proceeded to the Table, and after Prayers, took the Chair as Deputy Speaker, pursuant to the Standing Order.

Oral Answers to Questions

HEALTH

The Secretary of State was asked—

Accident and Emergency

Robert Wareing: What plans he has to reopen accident and emergency units that were closed during the last decade.

Mr. Deputy Speaker: Before I call the Minister, may I say that I shall be looking for short questions and concise answers.

John Hutton: Decisions about the configuration of A and E departments, including their closing or merging or the opening of new facilities, are a matter for local determination, taking into account local needs and clinical advice about safety and quality. The Government remain fully committed to modernising and improving A and E services throughout the NHS, which is why we have made the biggest investment in them since the NHS was established in 1948.

Robert Wareing: I thank my right hon. Friend for that answer. One of the A and E units closed during the last decade was that at Broadgreen hospital in Liverpool, and I believe that that closure has contributed to the increasing strains on the Royal Liverpool and Fazakerley hospitals. It is necessary to review the situation in Liverpool, so I hope that my right hon. Friend will visit the city and reach the same conclusion as me: that Broadgreen A and E unit and its associated services should reopen.

John Hutton: I listened closely to my hon. Friend's comments, and obviously we shall consider them carefully. I have been to Liverpool recently and I saw the A and E services at the Royal Liverpool hospital and the new walk-in centre at the Old Swan site, close to the old Broadgreen A and E site. Significant extra investment has gone into A and E services in his city, and all three hospitals providing A and E services in Liverpool are operating within their capacity limits. I am aware of his concerns and we are looking carefully at the situation.

Richard Taylor: Will the Secretary of State advise on how the A and E department at the tiny Hexham general hospital, which is only a few miles from his home, has been maintained?

John Hutton: Let me make one thing absolutely clear: I live 110 miles from Hexham, so the hon. Gentleman should check his facts before making allegations of that kind in this House. The circumstances of Kidderminster and Hexham are different. At Kidderminster, we decided no longer to provide blue light services because of the advice from local clinicians about the safety of those services. Such concerns were not expressed about services at Hexham.

Andy Burnham: Leigh lost its A and E department in the mid-1990s and people there are under no illusions about who is to blame for that. Although I accept that we cannot reopen an A and E department in Leigh, will the Minister give full consideration to the case for a new diagnostic and treatment centre at the Leigh infirmary site, using the spare capacity? It is well located, and separating acute services from elective admissions in the Wigan and Leigh trust makes good sense.

John Hutton: I strongly agree with my hon. Friend. The new diagnostic and treatment centres can make a positive contribution to elective and emergency services right across the NHS. We are considering a number of proposals to establish the new centres and we shall look carefully at his suggestion. An announcement will be made in the near future.

Crispin Blunt: Yesterday, after four and a half years of Labour Government, the East Surrey hospital A and E department had to close to 999 calls because there were 40 patients on trolleys; Crawley hospital had to do the same. That has appalling consequences for people coming in for elective surgery and appalling consequences for my constituent Philip Sprake, who could not be found a place in that hospital and had to be sent to Bromley, which is an hour away, and for his family. The trust is bankrupt, so the issue is certainly about money and resources. When will money and resources get to the trust? After four and a half years of Labour government, what is happening there is an absolute disgrace.

John Hutton: I have to tell the hon. Gentleman that very much more money and resources are reaching trusts in Surrey than was ever the case under the previous Administration. [Interruption.] It is no good him shaking his head, because he knows that that is precisely the case. I accept that the situation at that A and E is serious and we are looking closely into the exact circumstances, but his solution—more money—is one that we have already embraced. I am afraid that it is a lesson that his party has not yet learned.

Charlotte Atkins: Is my right hon. Friend aware of the excellent work of Government inspectors? They visited my local accident and emergency department in north Staffordshire recently and made 71 recommendations based on best practice. Does not that contrast with the days of the internal market when every hospital was in competition and best practice was not shared?

John Hutton: I agree. Such lessons were drawn out in Professor Sir Ian Kennedy's report. We have made a significant advance not only by establishing new national standards, including a new emergency care strategy, but by spreading best practice throughout the service.

Liam Fox: Further to the question that my hon. Friend the Member for Reigate (Mr. Blunt) asked, I have the facts about East Surrey primary care group. It states that the accident and emergency departments in both Redhill and Crawley will be closed to all admissions from 4.45 pm until the review at lunchtime on 22 January. What would happen in the case of a major road accident or an accident at Gatwick?

John Hutton: I do not know the details, but there are well-established contingency plans to deal with large-scale emergencies. The plans remain in place.

HIV

Neil Gerrard: What steps he will be taking to monitor HIV prevention work after April.

Yvette Cooper: The Department plans to monitor local HIV prevention through the AIDS (Control) Act 1987 and through the NHS performance assessment framework. That will include monitoring expenditure for groups most at risk of HIV, and developing performance indicators to assess progress towards meeting the prevention target in the sexual health and HIV strategy.

Neil Gerrard: My hon. Friend knows that some anxiety has been expressed about transferring commissioning to primary care trusts. I appreciate her comments about the Government's continuing to monitor. Will she assure us that that will continue beyond the next financial year into the following year, when primary care trusts become wholly responsible? If it is found that spending is not maintained, especially on vulnerable groups, will the Government be prepared to intervene?

Yvette Cooper: I can assure my hon. Friend that we envisage long-term arrangements for performance management on sexual health and HIV. It is right to bring that into the mainstream of the NHS, but we are not considering only transitional arrangements. We must continue to monitor progress to ensure that we achieve the challenging targets.

Peter Viggers: Can it really be true that nurses who are HIV-positive are being recruited? Do the Government believe that that poses no health hazard?

Yvette Cooper: No, it is not true.

Simon Burns: Does the Minister know about doctors' grave anxieties, especially in London, that female asylum seekers who come to this country from areas of high HIV infection are ignorant of the dangers of HIV and will not be tested? That means that those who are infected do not receive proper health care as early as possible and it places additional strains on the provision of health care by the NHS.

Yvette Cooper: It is clearly important that people with HIV/AIDS receive treatment. We are keen to increase testing and to ensure that we reduce the amount of undiagnosed HIV. The hon. Gentleman is right that that affects asylum seekers and others who have travelled abroad. We are reviewing the procedures for providing health care and testing for asylum seekers to ensure that we deal properly with any problems that arise.

Service Outsourcing

Martin Smyth: How many health authorities purchased services outwith their region in the last 12 months.

Alan Milburn: All 95 health authorities will have commissioned some services for their populations outside their region in the past 12 months, mainly for specialised services that are provided in relatively few hospitals in different parts of the United Kingdom.

Martin Smyth: I appreciate the difficulty in assessing what is happening and I welcome the fact that some people have recently been treated in France. Is it possible that, instead of caring for patients, health authorities that could not deal with waiting lists have refused to purchase elsewhere in order to protect jobs in their areas?

Alan Milburn: As the hon. Gentleman knows, we want to move from the traditional position whereby hospitals choose patients to one whereby patients have a greater say about their hospital treatment. The scheme to treat some patients in France is only a pilot scheme. The hon. Gentleman would rightly be the first to express anxiety if quality of care lapsed or if we did not get value for money. It is important to test schemes and get them right. Although they will be an important option in providing more choice for patients, I suspect that many patients will choose not to choose.

David Hinchliffe: My right hon. Friend mentions value for money in the context of purchasing from the private sector and providers abroad. What steps are being taken to ensure that the NHS gets value for money from such purchases?

Alan Milburn: As I have said to my hon. Friend on more than one occasion, both in the Chamber and before the Select Committee, there is no blank cheque. It is important that we can guarantee the right things to patients and to taxpayers: first, the highest possible standards of care and, secondly, good value for money. When there is spare capacity in the private sector, we should use it for the benefit of NHS patients, provided that the private sector passes those two important tests. Furthermore, as my hon. Friend is well aware, capacity in the mainstream national health service continues to be built, involving more beds, more hospitals, and more doctors and nurses. I hope that my hon. Friend will do what I do, which is to contrast the growth in the national health service now with the reductions that took place under the Conservatives.

Peter Lilley: Is the Secretary of State not aware that patients cannot choose to use facilities in their own region, let alone in others, unless their health authority has contracted to purchase care at those facilities? Patients have to follow the money, but surely money should follow patients. If the Secretary of State has done a U-turn on this issue, is he aware that there is more joy in heaven over one sinner who repents? We shall not believe that he has repented, however, until he withdraws the circular that forbids patients to choose care at a facility with which their local authority does not have a contract.

Alan Milburn: When the right hon. Gentleman was in government, he was never one to practise humility, as I remember. So far as the issue of money following patients is concerned, it is true that that is what the internal market, which he and his right hon. and hon. Friends devised, was supposed to achieve. But it never did. The money did not follow the patient; the patient ended up following the money, because the Conservatives had the absurd idea that the only way to raise standards in NHS hospitals was to foment competition among them. That was a failure then and, if we did it now, it would be a failure now.

Alan Simpson: Will the Secretary of State look carefully at the number of health authorities that actually pay for what they have purchased, rather than at those that purchase outside their area? In my area, two hospital trusts—the Queen's medical centre and Nottingham city hospital—regularly have to carry bills of about £1 million each for extra-contractual referrals from other areas. Those bills do not get paid. It is one thing to ask hospitals to meet their own targets; it is another thing to ask them to meet other people's targets using their own financial allocations.

Alan Milburn: My hon. Friend makes an extremely good point. Incidentally, he has two very good hospitals in his city, as he well knows. The system of extra-contractual referrals has gone. It was part and parcel of the internal market, which has now been replaced by a new system. He is quite right, however, to say that there is a faultline in the new system. When a hospital takes patients from outside its area, we do not recompense it immediately. Indeed, because of late payment, it has taken some hospitals up to two years to pay the hospitals that have taken their patients. We must change that, so that hospitals that treat more patients more quickly get more money more quickly.

Evan Harris: The tests for use of the private sector surely include value for money and accountability. Would it not deliver better value for money to free up the beds currently blocked in the health authorities where the Secretary of State is paying private companies over the odds to treat patients abroad, before trying the latter option? How can he demonstrate accountability when health authorities will not release to the House the value of the contracts to treat patients abroad, saying only that it is less than the very high cost that they are paying—over the odds—for private care in this country? How can that value for money be demonstrated in an accountable way?

Alan Milburn: It is a nice, simple world that the Liberal Democrats live in, where there is always a simple solution to every problem. There is not a simple solution to the problems in the national health service. We have to grow the capacity in the NHS, use it where we can elsewhere, and put the reforms in place. It is not simply a question of using spare capacity in the private sector, or of freeing up capacity in the NHS. The hon. Gentleman is quite right; we are trying to get the number of delayed discharge patients down by investing more in social services, and by providing intermediate care, rehabilitation and other forms of care. We are doing all those things, not just one of them.
	The hon. Gentleman knows as well as I do that the so-called secret contract between the primary care group and the hospitals in France is being evaluated. The primary care group will have to account for how it spends its share of the public money that it receives.

Tim Loughton: I am sure that we were all pleased for the nine NHS escapees who hobbled off for treatment at the private clinic in Lille last week. They will have been waved off enviously by the 1 million-plus patients who remain on waiting lists at home, not least the 42,000 and rising who have been waiting for more than a year. Will the Secretary of State now have another go at telling us exactly how much the treatment in Lille costs, including the associated travel costs, compared with the treatment available at private and not-for-profit centres here? Given the press reports about looking at using hospitals in Turkey, Tunisia and Malta, will he tell us just how far afield he is prepared to send our constituents before he gets to grips with the worsening crisis in treatment at home and puts an end to this national humiliation?

Alan Milburn: I do not think that it is a national humiliation to get more NHS patients treated more quickly. I know that the Conservatives never managed to achieve that, but that is what is happening. I have a little tip for the hon. Gentleman: he should not believe everything that he reads in the newspapers. It will make him a very unhappy person—I candidly tell him that, on occasions, it makes me very unhappy.
	There are no deals with other countries. We have one deal in a pilot scheme between one primary care group and one hospital in France. As for escapees from the national health service, there is one policy that the Conservatives would carry out: they would make every NHS patient an escapee, because they want to abandon the national health service.

Derriford Hospital

Gary Streeter: What assessment he has made of the capacity of Derriford Hospital, Plymouth, to meet the acute health needs of its community.

Hazel Blears: In February last year, we approved plans for a £101 million major redevelopment in Plymouth, which will significantly increase the capacity of the hospital.

Gary Streeter: The Minister refers to a new hospital that will come on stream in six or seven years, but what about levels of care for my constituents in the meantime? Given that the Government's own commission reported at the end of last year that it has been discovered that activity levels at Derriford hospital in Plymouth are three times higher than the national average, but that resources for the hospital are less than twice as high as the national average, is not the problem of the long-term funding structure the real reason why it often performs at 102 per cent. of capacity, why doctors and nurses are so hard pressed, and why so many operations are cancelled? After five years of a Labour Government, how much longer must my constituents wait for proper acute hospital health care?

Hazel Blears: It is true that there are problems of capacity in this country, and it is no wonder, because under the previous Government 60,000 beds were cut. Between 1980 and 1997, the NHS lost 60,000 beds. That is why there is a problem with capacity. At long last, under this Government, we now have a scheme to rebuild Derriford hospital.
	What has already happened at Derriford? [Interruption.] Let Opposition Members listen to what has already happened at Derriford: £6 million for a new cardiac unit; £3.5 million for a new cancer centre; £1.5 million for a new breast care unit; £820,000 for additional critical care beds; £765,000 for A and E modernisation; a new 10-bed observation ward planned in accident and emergency; four new wards for cardiac patients; and three wards to be released. That is just in Derriford. The rest of the country is also benefiting from the Labour Government, whereas people had to wait for years and years under the Tories.

Linda Gilroy: Does my hon. Friend agree that primary care trusts have an increasingly important role to play in easing not just winter pressures but all the seasonal pressures that affect hospitals these days? Does she further agree that private insurance has absolutely no role to play in solving those problems and, indeed, would make matters worse for many of my constituents?
	Ms Blears rose—

Mr. Deputy Speaker: Order. I remind the Minister that this question is about one particular hospital. I hope that she will not stray outside that.

Hazel Blears: Much as I am tempted to do so, Mr. Deputy Speaker, I shall not.
	My hon. Friend is absolutely right. Getting hospitals to work well is not just the responsibility of the acute trusts; it also depends on primary care trusts, on social services working together and on the whole health community coming together to achieve that. I am aware that senior managers are working in each other's organisations. Anne James, chief executive of Plymouth City primary care trust, has recently spent some time working in accident and emergency. What better way for professionals to experience the problems that they all face across the piece? I am delighted that, in this area, people are looking to modernisation and reform as well as investment.

Sexual Health

Sandra Gidley: If he will make a statement on the sexual health strategy.

Yvette Cooper: Consultation on the sexual health and HIV strategy ended on 21 December. An action plan is being developed. In addition, we have started to prepare for implementation by asking health authorities to undertake a baseline review, and by seeking expressions of interest in chlamydia screening.

Sandra Gidley: Is not the truth that the long-awaited strategy is little more than an HIV/AIDS strategy with a teenage pregnancy policy added on? Worthy as those matters are, should not the strategy include issues such as sexual dysfunction and endometriosis, which have a huge impact on people's lives? Most damaging, there is little emphasis in the strategy on barrier methods of contraception. I am glad that chlamydia screening has been mentioned because chlamydia rates have doubled in the past five years, along with those for other sexually transmitted diseases. But is it not too little, too late? Is not the Government's record the sexual equivalent of fiddling while Rome burns?

Yvette Cooper: I completely disagree. It is the first time that this country has ever had a comprehensive sexual health strategy. It covers issues around all kinds of sexually transmitted infections, contraception and abortion. It sets clear targets, including on preventing new transmissions of gonorrhoea. It has been widely welcomed across the country for focusing not simply on prevention but on integrating prevention and HIV/AIDS and sexual health services.

Meg Munn: Will my hon. Friend join me in congratulating young people in my constituency who have been involved in producing the local sexual health strategy? Does she agree that involving young people in producing such strategies is the best way to ensure that they are relevant to their needs and deal with issues around sexual health and reducing teenage pregnancy?

Yvette Cooper: I welcome the work to which my hon. Friend refers. It is true that a lot of the work on prevention is effective only when the groups at whom the work is aimed are involved in its development. With teenage pregnancies and preventing teenage pregnancies, it is particularly important to get teenagers involved. We are aware of the broad health impact of teenage pregnancies not simply on teenagers but on their children. That is why it is so important to keep on bringing the rates down.

Caesarean Section Births

Vincent Cable: If he will make a statement on the change in the proportion of babies born by Caesarean section in the last five years.

Jacqui Smith: The proportion of babies born by Caesarean section has risen gradually over the past five years. To help set standards on the use of Caesarean sections, the Department commissioned the national Caesarean section audit. The findings will form the basis of clinical guidelines to be issued by the National Institute for Clinical Excellence and the development of the national service framework for children.

Vincent Cable: Does the Minister share the assessment of the Royal College of Midwives that the number of operations at present—approximately double the level considered safe by the World Health Organisation—is unnecessary, unwanted, a major drain on NHS funding and a risk to mothers? If she does share that assessment, why are the Government not moving more urgently to reverse the trend?

Jacqui Smith: I think that I explained that the Government are moving urgently. There is no clinical consensus about the right level of Caesarean sections. Through NICE, we will be able to develop guidelines that mean that instead of focusing on overall levels we are able to ensure that the advice and the service that any individual woman receives, whether a Caesarean section or other forms of delivery, is appropriate. It is right that, building on the work that the Department has already done in gaining information, we now develop guidelines to ensure that the processes are appropriate for each woman. Alongside that, I am sure that the Royal College of Midwives recognises and appreciates the extra investment that the Government are putting into maternity services and into increasing the number of midwives available to support women.

Julia Drown: The Minister has spoken of the advice that parents should be given. The pregnancy book given out to parents-to-be says that the Caesarean operation is "safe", rather than pointing out that it is still a major operation and spelling out the risks, as the risks associated with other forms of childbirth would be spelled out. Will the Minister ensure that the guidance is looked at again, so that parents-to-be can be told about the risks associated with what is, as I have said, still a major operation?

Jacqui Smith: As I told the hon. Member for Twickenham (Dr. Cable), I think the information that individual women receive is crucial. Some of it will be given during discussions that they have with their obstetricians, and some will be published. One of the important jobs for the maternity component of the national service framework for children will be ensuring that the information we provide for women is available to them, so that they and their clinicians can make the best choices in each case.

David Tredinnick: Would not one way of reducing demand for Caesarean operations be to increase the supply of acupuncturists? At Derriford hospital in the constituency of my hon. Friend the Member for South–West Devon (Mr. Streeter), only 7.5 per cent. of babies are delivered by Caesarean.
	The working group on herbal medicines established by the Minister's Department, under Professor Pittilo—[Laughter]—not my right hon. Friend the Member for Kensington and Chelsea (Mr. Portillo). The working group will be looking at the regulation of acupuncture. Does that change in Government strategy represent original thinking?

Jacqui Smith: We wondered who would get the alternative medicine question today—but the hon. Gentleman makes an important point about the good work that is going on at Derriford hospital. When I visited a Walsall hospital maternity unit, I saw interesting work going on there as well. Midwives are being trained to use complementary therapies; indeed, more midwives are being trained throughout the country to use such therapies, and use them when appropriate.
	The remit of the working group under Professor Michael Pittilo—this is not, as some thought, a new job for one of the hon. Gentleman's colleagues—will be to present proposals to make self-regulation statutory for practitioners of herbal medicine, and proposals to revise provisions in the Medicines Act 1986 relating to the administering of such medicine. The group's recommendations will form a basis for wider public consultation before proposals are finalised and put to Parliament. I have no doubt that the hon. Gentleman will follow developments with the assiduity with which he follows all such matters.

Nurses

John Smith: What steps he is taking to improve the recruitment of nurses to the NHS.

Alan Milburn: Provisional figures show that 10,000 more nurses were working in the NHS in 2001 than in 2000. That is a consequence of better pay, improved child care and more flexible working.

John Smith: I welcome the good news about nurse recruitment, and congratulate my right hon. Friend and his team on their good work. Does he, however, recognise the vital part played by the Royal College of Nursing in both recruiting and retaining nurses, given its principal role of representing nurses' interests? Does he agree that the college should adopt the same high standards in protecting its own employees as apply to its members in the NHS? It should not be in the business of diddling former employees such as my constituent Mrs. Marilyn Reed out of their pension entitlements.

Alan Milburn: The news about recruitment is indeed very good. I well remember that when we announced the NHS plan in the House, the Opposition said we would never hit the target of an extra 20,000 nurses by 2004. Now, at the beginning of 2002, there are already 16,000 more. We are not just on target; we are well ahead of target. The RCN has played an important part in that, as have Unison and the other trade unions representing nurses at all levels in the NHS. We work closely together precisely to try to get the policies right, and not just bring nurses into the NHS but ensure that they stay.
	As far as internal issues as concerned, I think that they are a matter for the RCN.

Hywel Williams: There are 750 nursing vacancies in Wales. What steps are the Government taking to ensure that nurse training places are allocated to Wales to meet that need?

Alan Milburn: It is one of the joys of my life that I am not responsible for all things Welsh—not that all things Welsh, as personified by hon. Members of all parties, are not absolutely admirable. There is very good news about nurse training places. I note that the Universities and Colleges Admissions Service reports that the number of people applying for nursing degrees has risen by 18 per cent. in one year. The news is better with regard to applications for nurse diploma courses: they are up by 83 per cent.

Radiographers

Anne Campbell: What action he is taking to increase the supply of radiographers.

John Hutton: Measures are being taken to improve the recruitment and retention of radiographers. They include improvements in pay and cost-of-living allowances, increased provision of child care and of other means of supporting flexible employment, and increases in the availability of training courses. We are also working closely with the Society and College of Radiographers, running recruitment and return-to-practice campaigns. There are now over 700 more radiographers working in the NHS today than in 1997, an increase of 6 per cent.

Anne Campbell: I welcome the improvement in radiographer services at Addenbrooke's hospital. The provision of brand new linear accelerators has been very welcome, as they are much more efficient. They take longer to set up, however, which has increased the need for radiographers at the hospital. Will my hon. Friend consider using trained staff to administer radiotherapy? Such staff, being less than fully qualified, would work under the supervision of fully trained radiographers.

John Hutton: I am grateful for my hon. Friend's words of support, and the answer to her question is yes. Addenbrooke's is one of the 13 pilot sites that are currently helping shape new roles for what we call assistant practitioners in radiography. They can make a powerful and important contribution to dealing with some of the problems that my hon. Friend has identified, and to improving the service available to NHS patients.

Michael Fabricant: Does the right hon. Gentleman accept that there are variations in the recruitment of radiographers and nurses both within and between regions? That has a lot to do with the uncertainty about the continued existence of certain hospitals. On two occasions, the right hon. Gentleman was unable to see a delegation from Lichfield and Burntwood to discuss the future of hospitals in the area, where there is real uncertainty about the future of day surgery. We met the Under-Secretary of State in the other place, Lord Hunt of Kings Heath, in November. He promised to respond rapidly, but we still have not received a reply. When will we get a reply? When will we be able to recruit the nurses and radiographers that we need? This matter goes back to November.

John Hutton: The fact that I was unable to meet the delegation was not for want of trying, nor because I had no desire to meet the hon. Gentleman. The hon. Gentleman knows why I was not able to attend those meetings. On one occasion I had to travel to Ottawa to attend an international forum dealing with issues connected with bioterrorism. I hope that hon. Members would regard that as a pretty good reason. I shall write to the hon. Gentleman soon—

Michael Fabricant: Soon?

John Hutton: Today. The hon. Gentleman will get the letter later this afternoon. However, he may be interested to know that my right hon. Friend the Secretary of State is to hold a meeting on expanding access to day surgery tomorrow. I shall keep the hon. Gentleman informed of progress.

Lymington Community Hospital

Julian Lewis: If he will make a statement on the future of the Lymington community hospital.

Hazel Blears: New Forest primary care trust, which manages Lymington hospital, is developing proposals for a new hospital and plans to submit its outline business case to the NHS regional office next month.

Julian Lewis: I thank the Minister for that reply, although it is slightly uninformative. The existing health authority is to be wound up at the end of March, and replaced by a new strategic health authority. Is the hon. Lady aware of the New Forest primary care trust's concern that there is a risk that the funding allocated for the new hospital under the existing health authority might not be carried forward as a commitment by the new health authority? The trust is also worried that what might be termed planning blight will add to the hold-ups that have bedevilled the project for so many years. Can the Minister give a reassurance that the New Forest will not lose out in funding and suffer further delays as a result of the changeover to the new health authority?
	Ms Blears: I am aware that it has taken time for the project to reach fruition, but I am delighted at another example of delivery. I am aware also of how much the hon. Gentleman's constituents will value that facility. I am happy to reassure the hon. Gentleman that the matter has been brought to my attention and that I will follow it through. The plans are well advanced for 113 beds, two theatres, an endoscopy suite, outpatient services, X-ray facilities, dental services, pharmacy and pathology. It will be a wonderful enhancement to the hon. Gentleman's community and I hope that this Government will be able to deliver it.
	Dr. Liam Fox (Woodspring): What will be the implications for Lymington hospital and other building projects of the south-east region being overspent by £60 million, which will have to be paid for out of next year's allocation?

Hazel Blears: No, it will not. Hon. Members have become a little excited at the prospect of the south-east's financial position. The deficit that the south-east region is facing is about 1 per cent. of its budget and one eighth of 1 per cent. of the overall NHS budget. Such matters arise from time to time; they will be resolved. The majority of the deficit—some £51 million—is the result of increases in prescribing. Many drugs are being prescribed to prevent ill health in the first place.

Warrington, North (Appointees)

Mr. Deputy Speaker: Question 11, please.

Helen Jones: What progress has been made in appointing more people from the Warrington, North constituency to serve on health authorities and trusts.
	Several hon. Members rose—

Mr. Deputy Speaker: Order. Is there a Minister willing to answer Question 11?

Hazel Blears: Sorry, Mr. Deputy Speaker. The National Health Service Appointments Commission aims at ensuring that board membership reflects the geographical areas served by the bodies concerned. The criteria issued by the commission state that it is essential that candidates must live in the area served by the health authority or NHS trust—or in the case of a patient care trust, be registered as a patient of a general practitioner within the PCT area.

Helen Jones: My hon. Friend is possibly looking for the word "none" in her answer. The health service cannot meet the needs of those whom it is meant to serve unless people in the most health-deprived areas are represented in decision making. It is nonsense for the commission to argue that it cannot find suitable candidates to serve on NHS bodies from a constituency of more than 72,000 voters. My constituency and others like it have been badly let down. Most of the commission's recent appointments were from the wealthier areas of Warrington, South. It is a case of good chaps appointing other good chaps, and the golf club rules. What will the Minister do to redress inequality?

Hazel Blears: My hon. Friend raises an important point. If the health service is to be redesigned around patient needs, it is crucial that a proper cross-section of the public serve on boards. The new Commission for Patient and Public Involvement in Health will be charged with finding people who want to serve on health bodies, patients forums and panels—and in the governance of future health service bodies—to make sure that people from a much wider range of social backgrounds become involved. I am concerned about that matter and mean to make progress. Considerable progress has been made in recent years in appointing not just women but people with disabilities and from a range of ethnic backgrounds, but there is much more to be done.

Oliver Heald: Is the pattern of appointments to health bodies that serve Warrington, North the same nationally? The commission has appointed five times more Labour supporters than Conservatives or Liberal Democrats to NHS bodies—140 Labour, 30 Conservative and 31 Liberal Democrats. Those are the Minister's own figures, given in a parliamentary answer dated 8 January. What will the Minister do about the culture of Labour cronyism?

Hazel Blears: The commission does indeed appoint people on merit—people who properly represent their communities. The Commissioner for Public Appointments has just reviewed the appointments to primary care trusts, and she said that there was
	"no significant difference between the political activity of applicants and the political activity of the appointees".
	She concluded that there was
	"no evidence of any political bias in the appointments process".
	I am afraid, therefore, that Conservative Members will really have to do better and ensure that the appointments that are made on merit perhaps include some people with the ability to represent their communities.

Norfolk and Norwich Hospital (Access Road)

Richard Bacon: What discussions he has had with the Department for Transport, Local Government and the Regions and the Highways Agency concerning the provision of an access road for the new Norfolk and Norwich hospital; and if he will make a statement.

John Hutton: My noble Friend Lord Hunt of Kings Heath has raised the issue of access to the new Norfolk and Norwich university hospital with the Department for Transport, Local Government and the Regions. The Highways Agency has confirmed that the direct access road from the A47 to the new hospital cannot be approved, on grounds of safety.
	The national health service has so far spent more than £4 million on improving road access to the new hospital site, and an additional £1 million has been earmarked for further improvements. Norfolk county council is now urgently considering other options for improving access.

Richard Bacon: Does the Minister agree, while recognising that he is in no sense to blame, that it is unacceptable to spend £229 million of public money building a major new hospital and then not ensure that high-quality road access is provided as an integral part of the development? Will he use his good offices to apply every possible pressure to those responsible, to ensure that a speedy solution is found to that very important problem?

John Hutton: Yes, I am happy to give the hon. Gentleman that assurance and we are working very hard to ensure that there is a sensible outcome. There is widespread consensus that improved and better access to the hospital site is needed. A taskforce of the four local authorities concerned has been set up. I understand that its first meeting is next week and I am sure that the hon. Gentleman, if he is able to attend, would be welcome. If he cannot come, I will ensure that he is kept properly informed of progress.

Henry Bellingham: When looking at the road links, will the Minister also look at the A and E department of that hospital, which depends crucially on those road links? Did he see an article in the local newspaper the other day, headed, "Delays at A & E"? It said:
	"Patients were left waiting in a queue of ambulances outside a busy Norfolk casualty department because of a 'bottleneck' in dealing with patients, it emerged yesterday."
	Is it not a sad reflection on the Government that they cannot even build a brand new hospital and deliver for that hospital a proper, functioning, A and E department?

John Hutton: That is a very disappointing response from the hon. Gentleman. We do not want to stray too far into this territory, but his party had 18 years in which to build a new hospital for Norwich and it never quite managed to do it. We have built a new hospital. Yes, issues still need to be addressed, but my right hon. and hon. Friends and I have yet to hear one word of welcome for the new hospital from the hon. Gentleman.

Disabled People (Croydon)

Geraint Davies: What plans his Department has to support the provision of sustainable jobs for those with mental and physical disabilities in Croydon.

Jacqui Smith: Participation in employment is an important factor in promoting well-being and social inclusion. The Department of Health contributes to work in this area through a range of initiatives such as the welfare-to-work joint investment plans for disabled people, and the prominence given to employment issues in the national service framework for mental health and the learning disability White Paper, "Valuing People".

Geraint Davies: My hon. Friend will be aware of the very valuable work done by Crosfield Industries, which employs more than 100 people with disabilities, turns over more than £3 million of commercial revenue—

Michael Fabricant: Calm down. [Laughter.]

Geraint Davies: Thank you very much. It turns over more than £3 million of commercial revenue from windows, assembly and electrical work. It is supported by Government and council subsidy. Will my hon. Friend give her backing to continued Government support for providing sustainable jobs for people with disabilities—jobs which support them by caring for their physical and emotional needs and giving them a stake in the economy and society?

Jacqui Smith: I thank my hon. Friend for that question. Unlike Opposition Members, who have reacted to it with such hilarity, I think that providing work opportunities and the support necessary for disabled people is a pretty important and serious issue. I certainly would commend the work that Crosfield and Crosslink do with disabled people. That is part of the Government's workstep programme, which helps and supports 22,000 people throughout the country, enabling them to get or keep a job, and I understand that at least 90 people in my hon. Friend's constituency are supported in that way. I hope that he continues his support for that important work in his constituency; the Government certainly will.

Residential Care

Nick Gibb: How many beds for elderly people have been lost in residential homes between May 1997 and the latest available date.

Jacqui Smith: The Department's figures show that there were 261,600 residential care home places for older people in March 1997. That figure had fallen by 1,500, to 260,100, in March 2001.

Nick Gibb: It is strange that the hon. Lady cites those figures, because experts appointed by her Department—Laing and Buisson—show 49,000 fewer beds in residential care homes since 1997, as a consequence of which almost 6,500 beds are now being blocked in NHS hospitals. Is not that an absurd misallocation of scarce NHS resources?

Jacqui Smith: There are pressures on the care home sector. That, of course, is part of the reason why the Government are investing £300 million this year and next year, partly to help to stabilise the care home sector; but I really do not think that a discussion about this important issue is helped by Opposition Members' consistent misuse of figures. Laing and Buisson has no axe to grind, and the Laing and Buisson figures actually showed a net loss of 19,000 beds since 1996—a period in which there has also been a considerable increase in the number of older people receiving intensive care packages at home. In other words, we are doing what older people want us to do—helping them to be independent.

Kevin Brennan: My hon. Friend is right to concentrate on intensive home care packages. Is she aware of the report in this month's British Medical Journal that suggests that, if the NHS could reduce the acute bed/day average down to levels such as those in the Kaiser organisation in California, we could save up to 17 per cent. of the NHS budget? Does not that send the message that it is important to have such acute home care packages and that we should concentrate on reform, rather than just pouring money into the health service?

Jacqui Smith: My hon. Friend is absolutely right. That is why the investment that has already gone into intermediate care and the £300 million that the Government are providing over this year and next year is buying not only more care home places, but more intermediate care to keep people out of hospital and help them move more quickly from acute beds to independence. It is also buying more intensive home care, so more people are receiving nursing and other support to stay at home. This is a time of transition in the care that we provide to our older people, and a mature debate recognises that and the extra support that the Government are providing to help to promote independence and to maintain capacity in the care home sector; it does not focus on misusing statistics to the benefit of no one.

Nicholas Winterton: Although I appreciate the content of the Minister's replies to the questions that she has been asked on this subject, does she not agree that there is a problem with residential care for the elderly and that a number of elderly people require residential care? Although home care packages can play a very important part, there is a problem because of the increased costs that residential care proprietors have to incur. Will she not accept that there is a problem with the costs incurred in certain areas of the country, not least in my own, where a residential care home provided by an independent body—County Lifestyle Services—has closed in Cheshire? Will she not take account of the fact that some people require care homes for their retirement?

Jacqui Smith: I agree with the hon. Gentleman. Some people need care homes, and the fees and commissioning arrangements at local authority and local health service level are important for the publicly funded residents in those homes. That is why my predecessor set up a strategic commissioning group, to bring together representatives of local authorities and of independent health care and residential home providers to develop an agreement which the Government published at the same time as we invested £300 million in the system. The group also addressed the need for better commissioning and explicitly said that, when local authorities make decisions about fees, they should bear in mind the costs faced by care homes and the quality that we want for residential care provision.
	Decisions about fees are rightly made at local authority level. However, with the guidance and extra investment that the Government are putting into social services, it is possible to remodel our services and to maintain the necessary high-quality capacity in residential care to give a real choice to our older people.

NHS Dentistry

Ben Chapman: If he will make a statement on the availability of NHS dentistry.

Yvette Cooper: The Government are committed to ensuring that everyone who needs it can have access to NHS dental treatment. To support that, NHS Direct is now advising people on how to find dentists willing to provide NHS treatment in their local area.

Ben Chapman: Does my hon. Friend agree that everyone has the right to be on the list of an NHS dentist? Does she also agree that the best way to improve dental health, not least in poorer areas, is to increase further the number of available dentists? What specific plans does she have to retain or to recruit more dentists who are willing to provide a high-quality NHS service, rather than do as they currently do—which is to spend an ever increasing amount of time on private practice?

Yvette Cooper: I assure my hon. Friend that we are committed to increasing access to NHS dentistry. The number of dentists working in the NHS is increasing, and primary dental services have been established in his area. Through the use of dental access centres as well, we are increasing access to NHS dentistry for people in low-income areas. My hon. Friend is right to suggest that inequality issues also need to be addressed.

David Heath: Despite the assurances that we have been given over the years, is it not true that there are still huge gaps in NHS dentistry provision, not least in my county of Somerset where people still come to me because they cannot get an NHS dentist? Do we not best serve the interests of acute and long-term care by concentrating on primary care and making sure that we have the practitioners available in dentistry, optometry and general practice to provide universal and comprehensive primary care for our constituents?

Yvette Cooper: The hon. Gentleman is right to suggest that catching dental problems at an early stage is far better than palliative work later, and that the position varies across the country. We need to improve access at an early stage. However, we would be in a considerably better position now if hundreds of dentists had not left the NHS in the early 1990s, when the Conservative Government changed their contracts. We are putting in place incentive payments and improving things so as to bring dentists back into the NHS—but we would not be in this situation if previous decisions had not been taken.

Hospitals (Leeds)

Fabian Hamilton: If he will make a statement on the reconfiguration of hospital services in Leeds.

Hazel Blears: The creation of the single Leeds teaching hospitals NHS trust in 1998 provided an opportunity to improve service configuration across the city. Two major capital schemes are in PFI procurement: a major new wing at St James's university hospital to house mainly cancer services, and the redevelopment of Wharfedale general hospital at Otley.

Fabian Hamilton: Does my hon. Friend agree that the already excellent oncology services based on the St. James's university hospital site are in urgent need of upgrading, and that it is important that the PFI scheme that is currently on the books be moved on quickly, so that the services provided to the citizens of Leeds and outlying areas can be extended to the whole of west Yorkshire and beyond?

Hazel Blears: My hon. Friend is absolutely right. The new wing proposed at St. James's is a £160 million PFI scheme. I understand that building is to start in mid-2003 and that it will open at the end of 2006. It is crucial that swift and effective progress be made with the scheme, which is in line with our national priorities to modernise cancer services and to make sure that people, wherever they live, have access to the highest-quality services for such an important aspect of care.

Anne McIntosh: Although the Minister is right to focus the Government's attention on that form of specialisation, does she share my concern that even if the patients are not travelling, the specialists are, as they move between three different hospitals—Harrogate, Leeds and York? Does she not see enormous difficulties in that?

Hazel Blears: It is always a case of achieving a balance between the need to provide centres of excellence and local access to facilities, and either patients or consultants have to travel. It is for the local health community to design the optimal service for local people. It is right, however, that specialists and consultants should travel to see patients if that is the appropriate way to organise the system. That problem is yet more evidence of the need to reform the way in which services work. We need to put patients at the centre and design the service around their needs rather than around those of the professionals or of the system itself, as happened all too often in the past. This illustrates the need for investment and reform.

Point of Order

Michael Fabricant: On a point of order, Mr. Deputy Speaker. You will be aware that there are strict rules regarding the use of the Lobby when the House is sitting and governing who may or may not come into it and what they may do when they are there. Are you aware that at least one Lobby pass issued by the BBC has not been issued to a journalist and has been used at least once—I understand from others that it has been used many more times—not to gain information on Lobby terms from Members of Parliament but to influence them to vote in a way that favours the BBC's corporate interests? Is that not a gross abuse of the Lobby pass? Will the House of Commons investigate the circumstances surrounding that and issue clear guidelines defining when a journalist is indeed a journalist?

Mr. Deputy Speaker: I can assure the hon. Gentleman and the House that that matter is being investigated by the Serjeant at Arms.

Endangered Species (Illegal Trade)

David Amess: I beg to move,
	That leave be given to bring in a Bill to increase penalties for offences under the Endangered Species (Import and Export) Act 1976.
	Just in case unkind Members have it at the back of their minds that the Bill is about hereditary peers or Conservative Members of Parliament, let me make it clear that it is nothing of the kind.
	In common with other hon. Members, I am an animal lover. Indeed, when I return to my home the only thing that I can guarantee is that all my animals will be pleased to see me, pleased to be taken for a walk and pleased to be fed. The only sight more inspiring than my good wife bringing me a cup of tea in bed, which may or may not be laced with arsenic, is seeing wild animals in their natural habitat, and unless the House, the mother of Parliaments, takes endangered species seriously, we will no longer be able to enjoy seeing them in that habitat.
	I wonder how many hon. Members realise that it is possible to be arrested for poaching a pheasant in the United Kingdom, but not for selling a tiger, and that it is possible to be arrested for poaching deer or even salmon, but not for trading in ivory or rhino horn, which are derivatives of some of the most endangered species on the planet. Under current UK legislation, trading in endangered species is not an arrestable offence, and that is what the Bill attempts to amend.
	Globally, the illegal wildlife trade is estimated to be worth more than £5 billion a year, second only to illegal trafficking in drugs. It is estimated that in excess of 520 million animals and plants are traded each year, and about a quarter of the wildlife trade is thought to comprise illegal items.
	The United Kingdom, to our shame, is a major consumer of endangered species. For example, in a police operation involving a series of raids across the United Kingdom on premises selling traditional east Asian medicine, more than 20,000 medicinal products containing derivatives of rare and endangered species were seized. A survey by the wildlife trade monitoring programme, TRAFFIC, of Chinese medicine shops in the UK in 2000 found that 64 per cent. sold products that contained protected animal and plant species, including leopard, bear, musk deer and costas root.
	The impact of that trade on endangered species is huge. For example, the decline in the black rhino population is an appalling case study in the demise of an endangered species. In the early 1970s, the population was in excess of 65,000, but it has now fallen to just 2,500. The decline is partly due to poaching to fulfil the demand for rhino horn, primarily for traditional east Asian medicine. In 1998, a man was found to be in possession of 127 rhino horns, worth £2.8 million. Although he was found guilty of conspiracy to sell the rhino horns, they were returned to him on appeal. In 1998, the Metropolitan police raided a shop in Islington which was selling stuffed tiger cubs less than one week old; they were stuffed and mounted on a branch, and my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) and I saw them earlier today.
	In April 2000, UK police seized more than 130 shahtoosh shawls, which are made from the wool of a rare and endangered species of Tibetan antelope—the biggest ever seizure of such items in the world. That haul alone is thought to be worth more than £350,000; the shawls are estimated to represent just 2 per cent. of the world population of the species. The growing demand for shahtoosh has left a trail of blood from the Tibetan plateaux to the celebrities who unfortunately choose to wear them. Up to five Tibetan antelope are killed to make just one of those wretched shawls.
	In another case reported last week in the Daily Mail—I know that many hon. Members have talked about this—rare birds of prey were wedged into six-inch diameter plastic tubes in a bid to import them illegally from Asia. Twenty-three birds, all with their feet bound and with no access to food and water, had endured a 14-hour trip when they were discovered in two suitcases by customs officers.
	The trade in exotic pets, especially reptiles and amphibians, is flourishing. Every year, millions of wild animals are trapped for use in the exotic pet trade; most die before reaching the pet shops. The World Wild Fund for Nature—to which, along with the Royal Society for the Prevention of Cruelty to Animals, I am indebted—believes that that behaviour threatens the survival of many endangered species and damages their fragile ecosystems and habitats. Killing those animals denies local communities in their native countries the right to a sustainable livelihood. The aim of the convention on international trade in endangered species of wild flora and fauna is to restore the balance between humans and nature to ensure that people's use of wildlife is managed carefully so that it does not threaten either wildlife or the people who rely on it. The trade in endangered species seriously jeopardises that balance.
	Bringing those animals into the UK puts the public at risk. RSPCA inspectors helped police to uncover a collection of eight deadly snakes in a raid on a Sheffield flat last February. Unbelievably, a four-foot alligator currently in the Heathrow animal reception centre was abandoned in a telephone box, only to be found by a member of the general public. As the Minister knows, it is also possible that many of these animals could bring in diseases infectious to humans, crops or farm animals. A variety of birds and reptiles can spread very dangerous diseases.
	Yet the penalties for these crimes do not reflect their gravity. The company selling the shahtoosh worth more than £350,000 was fined only £1,500. The tiger cub trader was sentenced to only three months for selling a species that numbers only 5,000 in the wild. The maximum sentence for buying or selling an endangered species in this country is only two years—and the maximum sentence has never been awarded. Most criminals who are prosecuted for their crimes receive a fine that the World Wide Fund for Nature believes to be no deterrent whatever. Since these crimes are not arrestable offences, the police, who are responsible for enforcing international legislation protecting endangered species, cannot arrest these criminals. Bizarrely, they can only invite them down to the police station for questioning. Furthermore, as the offences are not arrestable, the police do not even record the statistics on these shocking crimes.
	In conclusion, I believe that the House can address this anomaly by increasing from two to five years the maximum sentences for offences concerning illegal trade in endangered species. That would make the offences arrestable. An arrestable offence carries with it not only powers of arrest, but other powers under the Police and Criminal Evidence Act 1984, which would provide the police with powers of entry without a warrant, powers of search and seizure and the ability to charge and bail people to court with conditions where appropriate. All hon. Members enjoy watching films about dinosaurs, but it would be a disgrace if the House were to do absolutely nothing and add to the number of dinosaurs. I commend the Bill to the House.
	Question put and agreed to.
	Bill ordered to be brought in by Mr. David Amess, Norman Baker, Mr. Ian Cawsey, Mrs. Helen Clark, Jane Griffiths, Mr. Mike Hancock, John Mann, Linda Perham, Mr. John Randall, Angela Watkinson, Miss Ann Widdecombe and Mr. Bill Wiggin.

Endangered Species (Illegal Trade)

Mr. David Amess accordingly presented a Bill to increase penalties for offences under the Endangered Species (Import and Export) Act 1976: And the same was read the First time; and ordered to be read a Second time on Friday 12 April, and to be printed [Bill 84].

Opposition Day
	 — 
	[8th Allotted Day]

Public Services

Mr. Deputy Speaker: We now move to the main business. I should announce to the House that I have selected the amendment in the name of the Prime Minister.

Liam Fox: I beg to move,
	That this House regrets the confusion over Government policy on the public services, which has contributed to a lack of morale and direction for those working within them and dependent upon them; urges Ministers to explain why they believe that greater private sector involvement and leadership will be good for the NHS but in their view was bad for Railtrack; requests the Secretary of State for Health to clarify whether it is his aim that there should be 'one monopoly provider' of health care or whether he believes that the NHS should 'no longer be a monopoly provider of care'; condemns the appointment of the unelected Lord Birt to preside over transport strategy; agrees with the Minister for Europe that Britain now has the worst rail network in Europe; deplores the fact that Labour Ministers failed to give priority to transport in their first term; further condemns the multiple failures of the Government's Education and Skills policy, including the collapse of the ILA scheme, the closure of Education Action Zones, and the reversal of the policy of exclusions, as well as the high numbers of teachers leaving the profession, the confusion over exam grades and the failure to consult over the future of student funding; calls for an end to the flow of paperwork and circulars from Whitehall which burden and undermine the professionalism of teachers; and, while paying tribute to the immense skill and dedication of many public servants, shares the public's disappointment that the standards of many public services are well below those prevailing in the rest of Europe.
	So, new Labour moves closer to its sixth year in office, but what has it meant for Britain's public services, for those who work in them and for those who use them? [Interruption.]

Mr. Deputy Speaker: Order. I want this debate to be conducted in an orderly manner and I certainly want to be able to hear hon. Members' contributions.

Liam Fox: How well has Labour matched its delivery to the enormous expectations that it raised before it was elected? Those are the questions that are central to our debate. The British public want to know what has happened to all the extra taxes that they paid for all the extra spending. Why is it that they have noticed no difference? We also want to examine whether there is any intellectual coherence in the Government's approach to policy making, or whether the constant proxy war of interference by Nos. 10 and 11 is making it impossible for Cabinet Ministers to exert any continuity whatever.
	It all began with such promise: education, education, education; tough on crime, tough on the causes of crime; 24 hours to save the NHS. But now teachers are increasingly demoralised and violent crime is rising. What of 24 hours to save the NHS? By summer 2000 that had become a 10-year vision in the NHS plan, and by autumn 2001 the Chancellor's Wanless report talked about a 20-year plan. Ministers feed us figures, send out glossy brochures and spend millions advertising their wonderful achievements, but for the users of the services things are completely different.

Phil Hope: Will the hon. Gentleman give way?

Liam Fox: Not before I have said anything.
	It is anyone's guess whether one waits longer these days on a railway platform or on a hospital trolley. Street crime, particularly in the capital, is rocketing. Post Office workers are threatening to strike; train drivers are striking; the morale of doctors and nurses is at rock bottom. Exam papers have unanswerable questions. Health authorities are dangerously overspent and hospitals lack the ability to undertake basic infection controls, so we intend to send more patients abroad—that is if they can get as far as the coast on our ever-ailing railways. All this occurs under the leadership of a Prime Minister who seems constantly to be appearing in yet another part of the world where diplomacy fuses with fashion, and to be increasingly disinterested in domestic affairs or completely out of touch with the reality faced by the public.

Phil Hope: Apart from the fact that an opinion poll gives the Prime Minister the highest approval rating since we got elected and the Leader of the Opposition a rating of only 13 per cent., the Opposition motion refers to
	"the closure of Education Action Zones"
	which will come as a bit of a surprise to my constituency, where the education action zone has just been extended. That is worth £2 million to Corby schools, Corby teachers and Corby pupils. The Opposition opposed education action zones, but they lament their closure and they are telling us lies because Corby's zone is being extended for two years.

Liam Fox: I can only suggest that the hon. Gentleman would be better off sticking to the questions given to him by the Whips, as he normally does, because the Government are abolishing the zones that he seeks to praise. Perhaps he should get his facts right before he intervenes.

Julia Drown: The hon. Gentleman said that he wanted to examine the intellectual coherence of the Government's arguments, but he both expressed the wish to have the Government interfering less and referred to the problems arising from exam questions. Is he seriously saying that Ministers should be sitting down and writing exam questions?

Liam Fox: The hon. Lady should not bother to intervene at all.
	We are suggesting that the Government's whole approach smacks of utter incompetence in education, transport, health, law and order and most of the other public services.

Several hon. Members: rose—

Liam Fox: I shall give way a little later to the hon. Gentlemen, if I can remember exactly who they are.
	The problems faced by our public services lie in the very ethos of new Labour. Like the Clinton Administration, its project is about coming to government and staying in government, not about what one does in government. Consequently we get endless reports and reviews. It is little wonder that a senior United States official is quoted this week as saying that Tony Blair seems more concerned about finessing a problem than dealing with it. How very perceptive.
	Moreover, while the presidential style undermines Secretaries of State, No. 10 increasingly interferes in what Secretaries of State are able to do. We have just had the Treasury's Wanless report on the funding of the NHS. That was about cutting those options available to the Secretary of State for Health which the Chancellor did not like. Of course, as No. 11 had a report on health, No. 10 has now commissioned a report on health as well—the Adair Turner report on the structure of the NHS for the latest master plan—but no terms of reference have been published, and there are no plans to publish the report itself. Neither we nor, presumably, the Department of Health will be given the information on which the Prime Minister's interference in the Secretary of State's health policy is to be based. Lord Birt has been commissioned by No. 10 to review transport policy, and of course as the Prime Minister is having a report, No. 11 has to have one too, and we now know that someone will review transport policy for the Treasury. What is going on?
	We have all been entertained when the Chancellor's men, as they like to describe themselves, call the Secretary of State useless in lobby briefings and the Commons watering holes echo with the briefings and counter-briefings of senior Ministers against their colleagues, but that culture, especially the seemingly endless tussle between No. 10 and the Treasury and between the Prime Minister and the Chancellor, is debilitating for the Government and has profound consequences for public policy.

Eric Illsley: First, does the hon. Gentleman not realise that education action zones were time limited in any event, so they will reach the end of their lives? Secondly, he talks about transport and the railways in particular, but can he explain why the Tory Government included a clause in the northern area franchise, which went to Northern Spirit, saying that the company had to reduce manning by 40 per cent? It sacked a lot of workers and drivers in particular. Now we have shortages. The privatisation was botched.

Liam Fox: First, more passengers have used the railways since privatisation, and passengers are what count on the railways. Secondly, hardly any Government policy has not been time limited and immediately overridden by a review—only a few weeks later in some examples—because the policies are so ill thought out. I shall take an intervention from the hon. Member for Harlow (Mr. Rammell)—they are getting easier.

Bill Rammell: Dream on. The hon. Gentleman referred to the role of policy advisers. One of the most senior under the last Conservative Government was Alfred Sherman, who wrote in The Guardian last week that any improvements to the rail service should be paid for solely by the rail commuter. Does the hon. Gentleman agree?

Liam Fox: Well, that is an intellectual step up. As someone once said, "Advisers advise; Ministers decide." I am sure that there is another one somewhere.

James Plaskitt: rose—

Liam Fox: Yes, I shall take that one.

James Plaskitt: The hon. Gentleman started his peroration by talking of no delivery across a range of services. May I tell him that 32 per cent. of Warwickshire primary school children were in classes of more than 30 in 1997 while today there are none in such classes? Does he call that no delivery?

Liam Fox: No Government can get everything wrong. Even this Government, by the law of averages, are bound to score the odd success, but up and down the country and right through the public services, which are far from being a great success with either service users or service providers, the Government are presiding over greater demoralisation than ever before among service providers and a greater lack of satisfaction than ever before among service users.

Several hon. Members: rose—

Liam Fox: I must get on, especially as those who are intervening cannot understand the difference between perorations and little perforations.
	Nowhere is the failure seen more clearly than in health. The recent scandal, which is all it can be called, of the fiddled waiting list figures, which was exposed by the National Audit Office, is one of the most appalling stains on the Government's record. We, and in fairness other parties in the House, warned that their obsession with waiting list figures would result in clinical distortions. When asked whether clinical distortions occur, Nigel Crisp, the NHS chief executive, said:
	"No doubt there are specific incidents where that has happened, and I have no doubt that people can see an incentive in doing that".
	What an appalling admission. The Prime Minister tried to understate the issue by telling the House that
	"it is important to put this matter in perspective. Over a period of four to five years, 6,000 people were misallocated on the lists."—[Official Report, 19 December 2001; Vol. 377, c. 281.]
	Only 6,000. They are not mere statistics; they are real people, sick people.
	Only last week, a GP friend told me that he had just returned from holiday only to find that his daughter had been taken off a waiting list because, while they were away, the health authority sent a letter saying, "If you don't write back within seven days, your name will be taken off the list." Now she has to go back to the end of the queue. What sort of system is that?
	In another hospital, the maxillofacial surgeons were forced to add patients to the waiting list and give a date of 23 December for treatment, knowing that no patient would volunteer to go in for facial surgery so close to Christmas. Those patients were therefore temporarily taken off the waiting list. That is the extent of the scandal in the NHS.

Angela Browning: I am sure that my hon. Friend will share the anxiety that I experienced after receiving a letter from a GP in my constituency. A consultant surgeon at the Royal Devon and Exeter hospital wrote to him to say that the hospital no longer took any notice of GP referrals when patients had deteriorated while on the waiting list. The consultant stated:
	"However, if even a single patient waits longer than 15 months there are enormous financial implications for the trust."
	The GP writes that he cannot interpret that in any other way than patients being treated by political diktat rather than GP referral.

Liam Fox: When I trained as a doctor, patients were treated on the basis of clinical need. That appears to have been abandoned under the current Government. My hon. Friend might be interested to know that the list of what the Government euphemistically describe as the "inappropriately suspended" consists of 75,000 patients. That means that 75,000 people in our country who need care are being denied it to make the Government's figures look better. That is a cause for national shame.
	The National Audit Office recommended that the Department of Health examined other trusts. It stated:
	"For example, they could investigate in more detail those trusts where more than 10 per cent. of patients are suspended and which have more than 2 per cent. of patients waiting more than twelve months for treatment. There are some thirteen trusts which currently meet both criteria."
	Have the Government commenced such an investigation? No. They do not want to know the embarrassing result. If the Secretary of State is genuinely anxious about the needs of patients who have been taken off the list for statistical reasons, I challenge him to announce immediately that such an investigation will be undertaken.
	More than 1 million people are on the in-patient waiting list. There are 2,000 more people waiting more than 12 months for their operations than in March 1997. There are 400,000 more people on the list for the waiting list. The Audit Commission stated that, in 1996, 73 per cent. of hospital patients were seen by a doctor in an hour. That figure has fallen to 53 per cent. The proportion of patients admitted to hospital in four hours was 90 per cent.; the figure has subsequently fallen to 76 per cent.

Phil Hope: Will the hon. Gentleman give way?

Liam Fox: No, once was enough.
	The Audit Commission was damning about the effects of Government policy on accident and emergency provision. Since 1998, a year after Labour came to office, it concluded that matters were not only getting worse but were doing so at an accelerating rate. The Secretary of State described that as "pretty disappointing". He was not half as disappointed as the 88-year-old man in Bristol who waited 22 hours on a trolley this week, or the patients who had the wheels taken off their trolleys so that they counted as beds, or those who circled hospitals in ambulances so that they did not start the accident and emergency clock ticking. That is more than disappointing; it is a disgrace.
	What will happen to the community health councils, which provided the data on what was happening in accident and emergency? The Secretary of State dealt with them in his best Queen of Hearts manner—"Off with their heads." They are to be replaced by a more complicated, less understandable, more expensive and unwelcome system. The judgment has been that although some CHCs work well, all should be abolished because some are not working. I should love that to apply to the Cabinet.

Geraint Davies: The hon. Gentleman knows that the National Audit Office report stated that up to 6,000 so-called fiddles may have occurred out of a total of 5 million patients. That is 0.1 per cent., and it applied to only nine out of 300 trusts. All the chief executives and chairs of those trusts have gone. Does the hon. Gentleman not realise that the Government are committed to stamping out all such fiddles? He completely misrepresented the statistics.

Liam Fox: Ah, well then, it is only 6,000 fiddles and nine trusts, is it? If the Government were as committed to stamping out this pernicious practice as the hon. Gentleman suggests, they would hold a full public inquiry into what these figures mean, rather than failing to ask the questions to which they do not want to know the answers.
	On top of this scandal, we still have mixed-sex wards; thousands of patients are still contracting hospital- acquired infections and dying unnecessarily; and we still have the scandal of dirty wards in the NHS.

Julia Drown: rose—

Liam Fox: The hon. Lady is very persistent. I shall give way.

Julia Drown: I want to point out that the same pressures to fiddle waiting lists existed under the Conservative Government. I was working in the health service at that time, and people came to me with the same suggestions. I hope that Ministers in that Government would have frowned on the practice and taken action. The hon. Gentleman needs to remember the background to these circumstances. The Labour Government have reduced waiting lists by more than 100,000. That is a fact, and it contrasts strongly with what happened under the Conservative Government, when waiting lists rose by 400,000.

Liam Fox: No, the hon. Lady fails to get the point. This Government have not reduced waiting lists; they have reduced the numbers on the lists. Those are two very different things. Sick patients are still waiting for treatment. What lies behind the Government's approach to this question is not just their obsession with numbers. For this Government, there is no such thing as truth and untruth; there is only convenience and inconvenience.
	Despite all these horrible statistics, one phrase echoes more than any other round Richmond House and the Treasury: "Where has our money gone?" Why are we all still getting letters saying that our constituents are waiting longer to see their GPs, waiting longer in casualty, and waiting longer for surgery? More people are coming to our constituency surgeries with these problems. If all this extra money is being spent, why are patients in the NHS not seeing any benefit?
	I shall give the House a simple example, involving last year's settlement for the NHS. The Government spent an extra £3.8 billion on the NHS last year; no one disputes that figure. However, when we take away the money that was inevitably spent on pay review bodies, pay costs, pensions, the debt overhangs and the Government's ring-fenced projects, the total amount available to expand core services was a maximum of about £560 million. That calculation assumes that the Government's national service frameworks came in at the bottom level of expectations.
	That explains the picture presented by the experts at the King's Fund—these are not our numbers, but those produced by the King's Fund—who highlight how the Government's extra funding has had little impact on activity levels. The King's Fund has stated:
	"The implication is that any reduction in the waiting list in the last three years has been achieved not through treating extra patients, but through fewer people being placed on to the waiting list each year. The figures show that there has been a fall in the rate of increase in NHS activity, despite a large increase in funding for the NHS. The most recent quarterly evidence suggests a decline in NHS elective activity."
	In other words, more money is going in, but less is coming out. Why? This is primarily due to the combined genius of the Health Secretary and his Minister of State, the right hon. Member for Barrow and Furness (Mr. Hutton), who have managed to lose—from the peak in 1996—49,000 care home beds, resulting in huge bed blocking right across the NHS. More than 6,000 NHS patients are stuck inappropriately in hospital at any one time—38 per cent. of them for more than a month, according to the Department's figures. There is a waiting list to get into hospital, and a waiting list to get back out. When they came to office, the Government claimed that the system had too little capacity; they have effectively managed to cut that capacity further. What a triumph!
	That triumph is matched only by the ability of the Secretary of State for Transport, Local Government and the Regions to survive in office.

Several hon. Members: rose—

Liam Fox: I shall not give way. I am perfectly capable of mocking the afflicted myself. That right hon. Gentleman should have resigned over his failure to sack Jo Moore. That whole wretched episode brought shame on the Government, and the Government's failure to act brought shame on this country. The right hon. Gentleman should have resigned over his calamitous handling of Railtrack. The Government's original estimate that Railtrack would be in administration for between three and six months has proved to be hopelessly optimistic. The latest estimates suggest that it could be as long as August 2003 before Railtrack's replacement is up and running. A report in The Times, which went unchallenged, estimated that the administration of Railtrack is costing the taxpayer more than £1 million a day. Of that, fees for advisers connected with Railtrack are estimated at £500,000 a day.

Ivan Henderson: rose—

Liam Fox: I should like to know whether the hon. Gentleman thinks that that represents value for taxpayers' money.

Ivan Henderson: May I give the hon. Gentleman some information that I received from the Library? I asked how many White Papers the previous Government introduced to Parliament from 1979 to 1997, and was informed that they introduced four. Thus in 18 years they introduced only four White Papers, two of which were for rail privatisation—we all know what happened there—and another was for bus deregulation, and we know what happened there, too. What was the hon. Gentleman's transport plan in those 18 years?

Liam Fox: The concept that after 18 years in government we issued only four White Papers is absolutely astonishing. Clearly, numeracy is not a quality required for Government Back Benchers.
	It is a sad truth that Labour Members will have to recognise that, in the big boy's class, when one has been in government for two terms, one must answer for what one has done and for what one has promised and failed to provide. There is no point in the Labour party, in its second term in government, going on about what the previous Conservative Government might have done two Parliaments ago. The Labour party is on trial today, and will be in future, for its failure to provide the people of this country with what it promised them at two general elections.

Clive Soley: Will the hon. Gentleman give way?

Liam Fox: I think that I have given way perfectly sufficiently up until now. [Hon. Members: "Give way."] I am not giving way at the moment.
	Not only has the Secretary of State's incompetence cost the taxpayer huge amounts of money, but performance on the rail network continues to deteriorate. Since Railtrack was placed in administration, performance has plummeted. Delays and cancellations caused by track and signal failures have risen by 45 per cent. since early October when Labour pulled the plug on Railtrack. The Government's 10-year plan for the railways is in tatters: £34 billion for the railways was meant to come from private sector funding by 2010, but having seen what the Government have just done to Railtrack, the private sector is unlikely to want to do business with a Government who have just confiscated a private company from its legal owners.
	The strategic rail plan was a complete flop.

John Redwood: My hon. Friend is making a magnificent and spirited attack on this lamentable Government and their performance on public services. Is he aware that they spent most of their first term trying to set up a Strategic Rail Authority—a new instrument of torture to destroy private interest in the railways—and are now spending their second term trying completely to reorganise it under a new chairman, because they accept that all that it did in the first term was a disaster?

Liam Fox: It is certainly very interesting, in the light of what my right hon. Friend has just said, to look at the different ways in which the Secretary of State for Health and the Transport Secretary are dealing with the results of their own incompetence. Both have reached the dizzy heights that they now occupy in the Cabinet on the third-way tide, yet the Transport Secretary now says that the third way was flaky and is busy reinventing himself as a born-again nationaliser.
	Meanwhile, the Secretary of State for Health tells us that he is the arch Blairite moderniser—in the words of the Transport Secretary, the chief flake now in the Cabinet—and he moves ever closer to a full-scale working amalgamation with the private sector, including using private sector management.
	I did not come to praise the Secretary of State for Health, and I shall leave burying him to his hon. Friends on the Back Benches, but he is the one who is heading in the right direction. He will need to be genuinely courageous in the face of not only Back-Bench but trade union hostility if he is to move in the right direction as he indicated last week. He will find that he will get a lot of support from many Labour commentators, who know that the policy of utilising the private sector more fully in our public services is the right one.
	As for the Secretary of State for Education and Skills, it is clear that she has been left a series of time bombs by the now Home Secretary. Teacher shortages, the chaos in student support and, the collapse of education action zones which the hon. Member for Corby (Phil Hope) did not know about, and individual learning accounts are all examples of the Home Secretary's legacy. The policy is littered with inconsistency.
	Before 1997, Labour attacked Conservative education reforms as bureaucratic. Teachers now think that they did not know what bureaucracy was under the previous Government. The Secretary of State for Education and Skills said:
	"I say to the House and to head teachers that sending teachers less paper will neither raise standards nor satisfy them of our ability to give them the support that they need to do the job."—[Official Report, 10 January 2002; Vol. 377, c. 661.]
	Who is she talking to?
	The Government tell us that they want new powers to crack down on disruptive and violent pupils, but they ordered that exclusions from school should be cut by a third by 2002 for purely political reasons, which robbed heads and governors of their independence in excluding disruptive pupils. There is intellectual incoherence, inconsistency and incompetence, all underpinned by the Government's dishonest claims to want to depoliticise the delivery of public services.
	The Government announced the setting up of the NHS Appointments Commission. The results of that fair, impartial, objective commission were given in a parliamentary answer: of those appointed, 30 were Conservatives, 32 were Liberal Democrats, nine were independents and 140 were Labour—how independent, objective and fair! Long live cronyism, the hallmark of Blairite new Labour!
	Not only do we have a Government of intellectual incoherence, inconsistency and incompetence where the Prime Minister becomes ever more detached; we have a Prime Minister who appears to grow ever more contemptuous of his party, which seems to exist only to glorify the cult of his personality, spawning a ministerial culture of blame, spin and reannouncement. This Government blame the professionals, their predecessors in government, the third way—anyone but themselves. If that fails, they set new targets, shift deadlines and commission new reports.
	Our transport system is in a mess. Violent crime is rising. The NHS is an international embarrassment. The Government do not know the problems and they certainly do not know the solutions. It is new Labour, new year, new panic, new policies—but never fear:—there will come a good day to bury them all.

Alan Milburn: I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
	'welcomes the Government's commitment to investment and reform in the public services and notes the contrast with 18 years of Conservative government, typified by under-investment and botched privatisations; recognises the progress being made on raising school standards, improving safety on the railways, cutting waiting times for NHS treatment and reducing levels of crime; wishes to see the ethos of public service strengthened in the country and recognises the importance of high quality public services to the creation of a fairer society; acknowledges the important role of public servants in achieving a fairer society and the contribution made to staff morale of growing staff numbers and rising staff pay; welcomes sustained investment in health, education, police, transport and local government and other areas of public service; believes that the Prime Minister's Principles of Public Service Reform are important to maximise the benefit gained from higher levels of public service investment; further believes that where public services do well they should benefit from greater decentralisation of power and resources, lighter inspection and greater local control; further believes that where public services fail to reach acceptable standards the Government has a responsibility to provide additional support and intervention whether that provider is in the public sector or, as with Railtrack, in the private sector; and contrasts this approach with that of the Opposition which tolerates failure in the railways, has no coherent plans to raise school standards, supports charging for NHS patients and wishes to cap government spending at 35 per cent. of GDP resulting in cuts to public services of at least £50 billion.'.
	What a load of claptrap we heard from the hon. Member for Woodspring (Dr. Fox). He does what he always does: he reminded the House that he once trained as a doctor. In that case, he should know a case of selective amnesia when he sees it. He talks about the state of the trains and conveniently forgets that his party presided over the botched privatisation of Railtrack and the rundown of the railways. It is no good him talking about nurse shortages, doctor shortages or bed shortages. It was his party and his Government who created those shortages.

Chris Grayling: Will the Secretary of State give way?

Alan Milburn: I will in a moment.
	Labour Members are proud of our record on public services and on the NHS.

Crispin Blunt: Will the Secretary of State give way?

Alan Milburn: I will in a moment.
	The Conservatives' problem is that they are ashamed of voting against the NHS in the first place, and of running it down over 18 years when they had the chance to build it. We know what the tactic of the hon. Member for Woodspring is: it is to try to air-brush his party out of history. Not even Joseph Stalin tried that.
	The hon. Gentleman should ask for a bit of help from some of his hon. Friends. Take the hon. Member for East Worthing and Shoreham (Tim Loughton), who is sitting next to him. I wish someone would! According to his CV, the hon. Gentleman is an expert on Mesopotamian archaeology. That means that he has spent a lot of time working with ancient relics from a bygone age, which is probably why he has a job on the Conservative Front Bench. The hon. Gentleman should get together with his friends. They can then unearth the true story of what the Conservatives did to the public services—run them down, cut them back, sell them off.

Crispin Blunt: In 1996, a new accident and emergency department opened at East Surrey hospital. Is the Secretary of State proud of his record, given that yesterday that department shut because it was so full of patients on trolleys that it could admit no more patients? It was not open for 999 calls.

Alan Milburn: Of course there are problems in the national health service: there are bound to be problems. There are problems in Surrey—which, incidentally, is why we have just increased the amount of money going into the Surrey health authority area. There have been years during which the NHS has not had the necessary investment, and has not had the necessary capacity. [Interruption.] Before Opposition Members get too excited, they should remember that when their party was in office the number of nurses and GPs in training remained the same. Now the number is rising.

Bill Wiggin: Perhaps that explains why, when I wrote to the Department about a constituent who had been waiting for 10 months for an investigatory operation relating to her bowel cancer, she was sent a letter telling her how wonderful the cut in waiting lists was. She has now been forced to pay for the operation. What a disgrace! Could the Department not have managed a better reply?

Alan Milburn: It is true that too many patients are waiting too long for treatment. How will we put that right? I will tell the House how we will put it right: we will put it right by investing more, and introducing reforms. The issue for the hon. Member for Woodspring and his party is this. Are they going to back the investment, and are they going to back the reforms? I will give way to the hon. Gentleman if he will do what his hon. Friend the Member for Woodspring has failed to do on successive occasions, and say that the Conservative party would match our spending on the national health service.

Mr. Deputy Speaker: Order. May I suggest to the right hon. Gentleman that it is never a good idea to tout for business in that way? I might conclude that he had finished his speech.

Chris Grayling: I want to take the Secretary of State back to his comments about the railways. Can he explain, given what he said about rail privatisation, why the Strategic Rail Authority set up by his Government said in its report
	"The private sector was playing a full part in financing the industry and delivering improvements"?

Alan Milburn: What the hon. Gentleman fails to recognise is that Railtrack was a botched privatisation. The hon. Gentleman should have a word with the right hon. Member for Haltemprice and Howden (David Davis), the chairman of the Conservative party. He did a sterling job when he was Chairman of the Public Accounts Committee. He reminded the House, and indeed the country, that because of the Conservative party's policy not only was the privatisation botched, but the party managed to sell off a state-run national asset and lose £6 billion in the process.
	If the hon. Gentleman is proud of that record, he must be the only person in the country who is. The truth is this. The Tories doubled crime; we have cut it. They increased infant class sizes; we have reduced them. They increased hospital waiting lists by 400,000; we have reduced them by 120,000.

Theresa May: Perhaps the right hon. Gentleman can tell us this. If the Railtrack privatisation was so botched, why are his Government proposing to leave Railtrack in the private sector and not to change the structure?

Alan Milburn: Our policy is extremely straightforward. According to the Tories' policy, what came first were the interests of shareholders. In our policy, the interests of the travelling public come first.

John Redwood: Will the Secretary of State give way?

Alan Milburn: In a moment. On second thoughts, the right hon. Gentleman may intervene now.

John Redwood: I am grateful to the Secretary of State. Will he confirm that it takes three years to train a nurse, and that this Government have been in power for five? Why are we still short of nurses?

Alan Milburn: I do not know whether the right hon. Gentleman is on this planet today but, if he was present for health questions earlier, he will have heard that there are 10,000 more nurses in the NHS this year than last year. Since this Government came to office, moreover, there are 27,000 more nurses in the NHS. The right hon. Gentleman should apply some compare-and-contrast strategies. When he was a member of the Conservative Government, the number of nurse training places was cut, as was the number of nurses.
	The Leader of the Opposition says that the Opposition's policy is based on principle. It is certainly based on Tory principles. It starts by talking down the public services. It continues with cutting back resources for the public services. It is completed by selling off the public services. The Tories' policy is the same as it used to be: talk it down, cut it back, sell it off. For 18 years, they had the chance to put in place the necessary investment and reforms, and they failed to do so.
	Talking of failure, I turn now to the Liberal Democrats. No doubt the hon. Member for Oxford, West and Abingdon (Dr. Harris) will be on his feet shortly, complaining that we did not invest enough, soon enough.

Evan Harris: indicated assent

Alan Milburn: That is the hon. Gentleman's story, but his problem is that he has the same answer for every question. He really is the man from Del Monte, who only ever wants to say yes. He says yes so often and so indiscriminately that I am surprised that it is not he who is getting engaged to the leader of the Liberal Democrats.
	If the Tories had their way, they would deny the public services the investment that they need, but the Liberal Democrats would deny the country the economic stability that it needs.

Don Foster: The Secretary of State is boasting about investment, but does the Government's 10-year plan for the railways mean that they intend to spend more in real terms on the railways each year than did the Conservative Government, or less? It is a straightforward question: more or less?

Alan Milburn: Over the 10-year period, we are planning to spend more. In the previous Parliament, we spent double what the previous Conservative Government spent in their final Parliament. In this Parliament, we will spend more again. The investment is going in, and needs to be matched by the reforms that we have initiated.
	The problem for the Liberal Democrats is that they are all for the investment, but against the reforms. The problem for the Conservatives is that they are all for reform and the abandonment of the public services, but they are not in favour of investing in them.

Liam Fox: The worst thing about the confusion from which the Secretary of State suffers is his lack of insight. Treasury figures show that managed expenditure on transport as a percentage of gross domestic product totalled 1 per cent. between 1997 and 2001, compared with 1.7 per cent. under the previous Conservative Administration.

Alan Milburn: Yes, but the hon. Gentleman's fixation with the private sector makes it surprising that he has failed to count both public and private investment. He should recognise the total level of investment going into the railways, and what that total will be. Investment is going in and we shall also harness the skills, expertise and resources of the private sector.
	With regard to health, Britain is the only country in Europe where public services receive a bigger share of national wealth. We lag behind other European countries on health spending but the NHS is the fastest-growing health service of any major country in Europe. The hon. Gentleman said that the grass is always greener on the other side and that we should abandon our form of NHS funding and change to the French or German system. The hon. Gentleman should realise from his travels that France and Germany do not have a superior system but a superior level of funding. We are putting that right.
	As I said earlier today, I do not regard people receiving treatment abroad as a national humiliation or disgrace but as a way of getting more NHS patients treated more quickly. I thought that the hon. Gentleman was all in favour of choice, as I am. I want patients to have more choice from the NHS. The only difference between patients travelling abroad for treatment and the hon. Gentleman travelling abroad to look at other forms of providing treatment is that at least NHS patients are well when they return.

Pete Wishart: The Secretary of State says that British hospitals are the finest in Europe. Is he aware that there have been no new patient admissions to the Victoria Memorial hospital in Glasgow because of acquired hospital infection? Last week, an Indian journalist who investigated the situation in Scottish hospitals concluded that hospitals in India were perhaps better than those in Scotland. What does the right hon. Gentleman say to that?

Alan Milburn: The hon. Gentleman does his constituents and the country no favours by falling for the trap set for him by the Daily Mail and others. He should go to Afghanistan or India to see what a third-world health care system really looks like. The British health service is being built up with more doctors, nurses and beds.
	There are problems with hospital acquired infection and I know that the Minister for Health and Community Care in Scotland takes them extremely seriously. The hon. Gentleman should not pretend that hospital acquired infection is solely a problem for this country's health service. It is associated with the greater range of prescribed antibiotics and other treatments and has occurred throughout the developed world. We have a good plan for dealing with it.

Ivan Henderson: Is my right hon. Friend aware that last weekend, the first emergency operating theatre ever opened at Colchester General hospital, which is used by my constituents? Is he further aware of the major upgrading of the trauma theatre and that an MRI scanner is being delivered this weekend? Did my right hon. Friend know of the comment by Essex Rivers Healthcare trust in a press statement that it wanted to build an emergency theatre for many years but was hampered by lack of funds? Does my right hon. Friend believe the people working at the front line, who can see this Government deliver, or Conservative Members, who are always running the health service down?

Alan Milburn: My hon. Friend tells an important story. Investment is being made and reforms are biting. Nobody pretends that everything is fixed but nor should anyone pretend that everything is broken. We know that there is a long way to go. The NHS will require sustained investment over a period of years. Only a fool or a Liberal Democrat believes that a few years of extra investment will put right decades of underinvestment.
	My hon. Friend may have seen the report published by the NHS Modernisation Board a week or so ago. Not even the hon. Member for Woodspring can claim that that board is stacked with cronies from the Labour party. Its members are from the British Medical Association, the Royal College of Nursing, the royal medical colleges, Unison and patients' organisations. The board told the truth about the NHS today. It has profound problems but progress is coming through. In the past year alone, there has been a net increase of 10,000 nurses and the number of hospital beds rose for the first time in 30 years. More than nine out of 10 cancer patients are now seen within two weeks, when they used to wait months. In just one year, there have been almost 5,000 more heart operations and there are 17 per cent. more heart doctors. We do not claim that every problem is solved, but nor should anyone claim that progress is not under way.

Angela Browning: The right hon. Gentleman may recall my intervention on my hon. Friend the Member for Woodspring about the Royal Devon and Exeter hospital. Will he please explain, because the doctors in my constituency would be interested in his answer, why a consultant orthopaedic surgeon feels obliged to write to a GP:
	"We are presently only operating on long waiters, much against our better judgement"?
	It is not that the surgeons are unsympathetic to long waiters, but clearly, in terms of clinical priority, the Secretary of State's judgment is now deemed to be more important than that of consultant surgeons or GPs.

Alan Milburn: If the hon. Lady thinks that clinical need is as important as I do—

Angela Browning: Not me—the doctors.

Alan Milburn: The hon. Lady raised the point, not the doctor. If the hon. Lady thinks that clinical need is as important as I do, why, when she was in government, did she not urge the then Health Secretary to do what this Health Secretary has done: put more money into shortening waiting times and improving cancer services and heart services?

Several hon. Members: rose—

Alan Milburn: Oh, there is a posse of them. They are all the same, really; I will take that one.

Julian Brazier: I am grateful to the Secretary of State for giving way. The Secretary of State is planning a £150 million reorganisation in my constituency area. Is he aware that 15,000 people have marched against that proposal, because it will involve taking away our A and E, threaten the cancer centre currently located in Canterbury and, in the view of no fewer than 12 consultants who turned out at a few hours' notice, ruin the standard of health care in our area?

Eric Illsley: Will my right hon. Friend give way?

Alan Milburn: It is very tempting, but let me just deal with the point that the hon. Member for Canterbury (Mr. Brazier) raises, because it is very important. I know that there is concern in his constituency and that he joined many of his constituents in a sit-down protest the other day. Some of my hon. Friends would say that that was the best place for him, but that would be extremely uncharitable.
	I know that there is concern in the east Kent area about the situation. The hon. Gentleman has raised those concerns with me more than once. I will of course look at the issues, but he should not pretend that these issues have been brought about as a consequence of some sort of financial decision-making structure; they have not. As the hon. Gentleman knows, they have been brought about and led by clinical decision making. Sometimes that raises profoundly difficult issues in terms of access to local services. It raised difficult issues for the previous Government. It raises difficult issues for the present Government but we should not try to duck them.

Several hon. Members: rose—

Alan Milburn: Now, who else? That one there.

Gregory Barker: I was interested in the right hon. Gentleman's statement on investment in the railways. Can he commit the Government today to the £500 million that will be necessary to electrify properly the line from Hastings to London to enable the new rolling stock that has already been ordered by Connex to run? Without that commitment, the new rolling stock, which is detailed in the strategic rail plan of the Secretary of State for Transport, Local Government and the Regions, is completely worthless.

Alan Milburn: I have got the point. That is an issue for the Transport Secretary. [Hon. Members: "Oh."] We actually have a very good Transport Secretary. [Interruption.] Oh yes, we have a very good Transport Secretary and I know that he will more than happily reply to the hon. Gentleman's question.

Several hon. Members: rose—

Alan Milburn: Who is next? That one.

George Osborne: May I bring the Secretary of State back to the health service? Will he explain why a written answer that I received from his Department confirms that more than 35 trusts, including my local trust, have more than 10 per cent. of their patients suspended from the waiting list for an in-patient operation? Will he answer the point that my hon. Friend the Member for Woodspring (Dr. Fox) made and accept the National Audit Office's recommendation for an inquiry into those trusts where there is huge suspicion of waiting list fiddles?

Alan Milburn: The hon. Gentleman is slightly behind the times. We have actually gone further than the National Audit Office suggested. We have said that in future the Audit Commission, the other Government watchdog on public spending, will be able to spot-check waiting lists, not just in his trust but in any trust that it chooses in the country. But let the hon. Gentleman not fall for the fallacy being peddled by the hon. Member for Woodspring, that the reduction in waiting lists comes about as a result of fiddling figures. It does not. It comes about as a result of treating patients. Half a million more patients are being treated every year in the NHS.
	In health, the extra doctors, nurses and beds are providing shorter waiting times for patients. In education, the extra teachers and smaller classes are improving standards for pupils. In our cities and on our streets, the record increase in police numbers is helping to reduce crime. In transport, despite the obvious problems on the railways, more people are travelling by train, as well as by bus, than ever before. We do not say for a moment that our public services are as good as we want them to be, but the difference between us and the Conservatives is simple enough: we want our public services to succeed; they do not believe that they can ever succeed. We are putting in the resources; if they had the chance, they would take out the resources.

Clive Soley: My right hon. Friend is being very generous in taking interventions, but an increasing number of Labour Members are getting very angry about the interventions on investment made by Conservative Members, given that not only was there a history of intervention, but the shadow Secretary of State for Health refused to answer the question about more investment on the "Today" programme. He refused to take an intervention from me that he knew would be on the same point, and until Conservative Members—whether Front Benchers or Back Benchers—are prepared to say, first, that they will not make the cuts that they made previously and, secondly, that they will match or increase our funding, no one, but no one, should take them seriously.

Alan Milburn: My hon. Friend is absolutely right. The hon. Member for Woodspring has had two chances today. He had a chance on the BBC's "Today" programme this morning to say that he would match Labour's spending on health. My hon. Friends gave him a chance to do that in Health questions, and I am happy to give way now to give the hon. Gentleman a third chance, if he wants one, to say that he will match Labour's spending on health.

Several hon. Members: rose—

Alan Milburn: I shall give way to the hon. Member for Rayleigh (Mr. Francois). Can he make that pledge?

Mark Francois: The Secretary of State mentions cancer patients, and I wish to ask him a specific question on that point. Will he please explain to the House why his Department has recently announced plans to run down the highly successful cancer service at Southend hospital? What have the people of Southend and the surrounding constituencies, including mine, done to deserve this Government reducing the level of cancer care available to them?

Alan Milburn: I am sorry to say that I am not familiar with the individual—[Interruption.] The hon. Gentleman asks a question; I will give him an answer, and if he would care to listen, he might learn something. I am not familiar with the individual case that he raises. I will look into it, but it is simply wrong to say that, somehow or other, we not building up cancer services. We are building up cancer services—more money is going in than ever before. Indeed, one of the big differences between this Government and the previous Government is that we are ear-marking money specifically for cancer services. One of the eternal shames for the Conservative party when in government is that it did not put a penny piece aside for specialist investment in cancer services, and the legacy is with us today.
	Instead of learning from their history, the Conservatives are still living in it. For them, public is bad, private is good. The biggest problem in the public services for them is not lack of investment by the state; it is the size of the state. Only the Tory party could think that the best way to get more out of the public services is to put less in. The Tories, frankly—

Adam Price: Will the Secretary of State give way?

Alan Milburn: No, I shall not give way.

Adam Price: rose—

Alan Milburn: Oh, I will give way—why not?

Adam Price: I am grateful to the right hon. Gentleman for giving way. I am as surprised as he is to hear about the Tories new-found enthusiasm for public services, but surely 18 years of Tory neglect is not a justification for five years of Labour complacency. Was not the Deputy Prime Minister right last week to refer to the cruel shambles of the state of public services in our poorest communities? They have the worst schools, the worst housing and the longest waiting lists. For 18 years, Labour canvassers used to tell us, "It'll be all right when we get a Labour Government." Well, we are still waiting, aren't we?

Simon Burns: The right hon. Gentleman does not do Wales.

Alan Milburn: I do not do Wales, as the hon. Gentleman rightly says. However, I occasionally like to do people from Wales. The hon. Member for East Carmarthen and Dinefwr (Adam Price) has fallen into the trap that the hon. Member for Woodspring set for him. Unless we solve every problem, no problem is solved. Is that what the hon. Member for East Carmarthen and Dinefwr is suggesting? Unemployment is lower, living standards are higher, the working families tax credit is in place, child poverty is being tackled, the minimum wage is in place and there is more investment in the public services. No, not every problem has been solved—amazingly enough—after four and a half years, but progress is being made. If we went back to the years of cutback and closure, not only would we have less investment in our public services but we would not have the reforms either.

Eric Illsley: I wish to drag my right hon. Friend back to a point that was made earlier about clinical priorities. It was suggested that the ability of GPs to refer people to hospital was being hampered. Does my right hon. Friend recall the situation that existed in Sheffield under the last Conservative Government? Sheffield hospitals refused to accept patients from non-fundholding GPs, because the money did not come with the patient. That was the result of the underfunding of hospitals in the Sheffield area.

Alan Milburn: I remember that very well. The tragedy is that that was not an accident but a deliberate act of policy. The policy then was to foment competition among hospitals, to split the NHS up and to fragment it. The result was clear for all to see. We did not even have competition and we certainly did not have higher standards in my hon. Friend's constituency or in mine. We have all learned the lessons from that, haven't we?
	The truth is that the Conservatives are still living in the past. The shadow Chancellor, the Leader of the Opposition and the shadow Home Secretary are all in search of a new holy grail. They have lost two elections, but they have found a new cause: reducing public spending to below 35 per cent. of GDP. Let me be clear about it. Reducing public spending to that level would require at least £50 billion of public spending cuts. That is the equivalent of the total NHS annual budget for the whole country. The Conservatives have the temerity to complain about our targets to improve public services, but their target would destroy public services.
	We stand for public services, because we stand for a fairer society. For Labour Members, public services are social justice made real. Without better schools, too many children miss out on the best start in life; unless we tackle crime, the poorest communities always pay the price; and without a better NHS, too many patients face the dilemma of having to pay for treatment or wait for treatment.
	The hon. Member for Woodspring says that we should be clear where we stand. We stand where we have always stood—for an NHS that is paid for by all, that is available to all and that provides patients with care that is free and funded from general taxation and based on the scale of their needs and not on the size of their wallets. The former Prime Minister Lady Thatcher once famously said that she wanted the hospital of her choosing, on the day of her choosing and at the time of her choosing. That is what we want too; we want it on the NHS. That is why we are putting in the investment and the reforms: to get waiting times down and to allow patients to choose when they are treated on the NHS and where they are treated on the NHS, rather than forcing them out of the NHS.
	To Labour Members, improving public services has never been just about investment or just about reform. It is about both. So whether it is in health or in education, there will be tough national standards within which schools and hospitals will have greater freedom to deliver. Where services are doing well, there will be less intervention; where they are not, there will be more. In health, education and transport, we will use the private sector where it can help the public sector.
	If there are consistent failures in management—whether it be a failure in public sector management or in private sector management—our response will be the same. We will change the management. That is what my right hon. Friend the Secretary of State for Transport, Local Government and the Regions has rightly done with Railtrack and what my right hon. Friends the Home Secretary and the Secretary of State for Education and Skills have done with failing schools. It is what I will do if necessary with the small minority of failing hospitals. Whether it is patients, pupils or passengers, we will not tolerate second-rate services for some when the best should be available for all.
	This debate has exposed the Conservatives' cosmetic concerns for public services. It has demonstrated the determination of Labour Members to make the investment and reforms necessary to improve those public services. Public services and the people who work in them—the teachers, the doctors, the nurses, the police officers and the people who drive the trains—make a valued and valuable contribution to the fairer society that we seek to build. They are essential to the quality of life in communities and constituencies in all parts of our country. Yes, there is plenty more to do and there are improvements to be made, but improvements cannot come by cutting back the investment or by scaling back the reforms.
	It is the Labour party that believes in an NHS that is free at the point of need; it is the Conservative party that does not want choices for patients—it wants charges for patients. It is the Labour party that believes in putting more money into the NHS; it is the Conservative party that would take that money out of the NHS. Just as it was the Labour party that created the health service and the Conservative party that opposed it, so it will be the Labour party that reforms the NHS against a Conservative party that seeks to reject it. We know that the choice before the country is the choice before the House; it is between Labour Members who would reform the public services and Conservative Members who would wreck the public services.

Evan Harris: The noise, shouting and macho posturing in the Chamber can mean one of two things: either the Conservative and Labour parties are far apart on an issue or they are close together on it. I suspect that when it comes to dealing with the public services, it is the latter, and they are both wrong. They wish to disguise their unwillingness to tackle the issues, to disguise their unwillingness to own up to the cost of funding decent public services, and to disguise their uncritical love affair with the private sector.
	Only a fraud or a Labour Minister would claim to be able to save the NHS without significant sustained early extra investment. Only a fraud or a Labour Minister would claim that a headlong rush towards the private sector in many of our public services will not lead to problems of both accountability and value for money.

Angela Browning: On the subject of the love of the private sector, why did the hon. Member for North Cornwall (Mr. Tyler) enclose a brochure on the Nuffield clinic in Plymouth in literature that he circulated to his constituency last year?

Evan Harris: I know little about the constituency of my hon. Friend the Member for North Cornwall (Mr. Tyler). I suspect, however, that I now know more about the weakness of the Conservative unit on the Liberal Democrats, and I hope that I sample more of that weakness during my contribution.
	In the 1997 Labour manifesto the Prime Minister wrote:
	"we have made it our guiding rule not to promise what we cannot deliver; and to deliver what we promise."
	That will be hard for people who use the public services to take. [Interruption.] If the Secretary of State listens, he will recognise that without putting in the funding early, patients, pupils and others will be let down. In the four years following that commitment, the funding provided by the Government for many public services barely exceeded—if at all—the funding provided by the Conservative party when it was in office. Yet expectations were hugely raised, and it is the failure to deliver on those expectations that has made so many people feel let down.

Liam Fox: In order to buy the hon. Gentleman some time so that the massed ranks of the Liberal Democrats can come to support him, in terms of early investment, how much was 1p in income tax worth in 1997?

Evan Harris: If the hon. Gentleman waits, he will hear me happily defend our tax proposals in the 1997 and 2001 elections. It is indeed those proposals and our menu with prices that set us apart from the two conservative parties that are opposing each other in the debate.
	One might ask why it matters that expectations were raised when the delivery—if it arrives at all—will be so delayed. It matters because the patients who voted for the Labour party in 1997, believing that it would save the NHS in two weeks, 12 hours, 24 hours or whatever the jargon was, had only one chance of treatment. They cannot wait four, five, six, seven or eight years for the Labour party to deliver their health care. Children entering school have only one chance of education and cannot wait eight years for the Labour party to deliver its education promises.
	The Government wasted three years by sticking to Conservative spending plans. They said two things—that they would save the NHS and that no one would ever pay more tax under a Labour Government—in 1997. They therefore made two incompatible pledges. We know that they met their pledge to the better-off, but they let down pupils, patients and passengers to meet it, which they should never have done.

David Cairns: The hon. Gentleman will not know this, but Inverclyde council has submitted a bid for £100 million of public-private funding to make much-needed improvements to schools throughout Inverclyde. The local Liberal Democrats, who are in opposition on the council, opposed that bid, although Mr. Ross Finnie, a Liberal Democrat Member of the Scottish Executive supports it. What is the policy of Liberal Democrat Members of Parliament? Do they support that extra funding for schools or do they oppose it?

Evan Harris: We are happy to say where we stand on the private finance initiative; we do not oppose it in principle, but it must pass tests—[Interruption.] That is what I mean about the uncritical attitude of Labour Members; if the word "private" is mentioned, they are told via their bleepers that they have to back it. Tests have to be met. The hon. Member for Greenock and Inverclyde (David Cairns) would do better on scrutiny if he asked the people proposing that scheme whether it delivers value for money; whether there is adequate accountability; whether there is adequate risk transfer if it involves private finance; whether there is sufficient flexibility; and whether it will deliver those in the long term. I fear that he does not bother to ask those questions because he has been told from on high that he must support such initiatives. Liberal Democrat Members will always give practical scrutiny to such proposals—[Interruption.] I believe that I have answered that point.
	The first three years of the Labour Administration were wasted by sticking to Tory spending plans while our public services went down the pan.

Martin Salter: Will the hon. Gentleman give way?

Evan Harris: No, I want to move on.
	Those three years were not entirely wasted by them because they were three years of spin; multiple reannouncements of funding and triple counting were used as a disguise for underinvestment. The final year of the Administration's first term, when they recognised that they had not delivered on their pledges, was a year of controlled panic; as they approached the election, there were longer waiting times for patients, poorer education and even more under-representation of poorer students in higher education. We are in the first year of the Government's second term, and it looks like there will be four years of uncontrolled panic, as they settle for reannouncements, interference, reviews and micro-management of the NHS as a substitute for early investment.

Martin Salter: rose—

Evan Harris: I can see that the hon. Gentleman, who is clutching a briefing, is desperate to intervene.

Martin Salter: It is a newspaper. I should have thought that even people in Oxford, West and Abingdon read The Guardian from time to time.
	The hon. Gentleman's criticism of the Labour Government for sticking to Conservative spending limits might be valid if—

Evan Harris: rose—

Martin Salter: Wait for it; settle down.
	The hon. Gentleman's criticisms might be legitimate if we did not read in The Guardian today that the Liberal Democrat strategy for targeting areas such as Guildford and elsewhere in Surrey involves the right hon. Member for Ross, Skye and Inverness, West (Mr. Kennedy) holding out the prospect of tax cuts. How does that sit fair and square with the tax and spend ideology that the Liberals are now embracing? The one thing that we can guarantee with Liberals is that they will never ever be consistent on any single point of principle.

Evan Harris: The hon. Gentleman has made a fundamental mistake; he has read The Guardian, not the Liberal Democrat manifesto. Until he reads our policies, he cannot readily criticise them. What separates us from the Labour party is the fact that when we make commitments, we explain how they are funded and go into the election saying how they are funded.

Bill Rammell: In terms of clarity about how the Liberal Democrats fund their policies, does the hon. Gentleman agree with the hon. Member for Winchester (Mr. Oaten), who said:
	"I think when we debate public services, when we look at the health service, we need to throw into the equation . . . you won't like this, we need to look at the issues of insurance, we need to look at the issues of charging"?

Evan Harris: Before we reject those propositions—I hope and believe that the Conservatives will not do so—we will give the reasons why they are rejected.

Bill Rammell: rose—

Evan Harris: The hon. Gentleman has become excited now that I have answered his question. We approach all these issues—especially important ones such as how we fund the health service—on the basis of pragmatic tests of equity, value for money, accountability, access and so on. As I shall demonstrate—I shall deal with his point—I believe that, while the Conservative policy of charging for the health service is at least a policy—

Tim Loughton: There isn't one.

Evan Harris: They are thinking about it. It is at least a policy, but it fails many of the tests that I have mentioned. [Interruption.] I urge the hon. Gentleman to control himself, as I will scrutinise the policy that he is considering and offer some advice to him.
	The threat to the NHS comes not from the Conservative party, which people will never believe to be a friend of the NHS, but from the Government. Most murders happen in the family, and it is the Labour party, which is still believed by many people to have the best interests of the NHS at heart, that may well be sounding the death knell for the future of the health service. Through its failure to deliver, and especially its spin and multiple reannouncements about funding, it is leading many people to believe that a properly funded NHS has been tried and has failed.
	The Liberal Democrats argue that the concept of a properly funded health service that is paid for by taxation and is free at the point of delivery is currently failing only because it has never been tried. The health service has not been properly funded. Every time Labour Back Benchers, speaking out of loyalty, or Ministers, sticking to their press briefing, reannounce the funds and give an inflated impression of the money that is available to the health service, they drive a nail into the future of the NHS and its survival as a publicly funded service. Even in The Guardian, there will be people who believe the Government's figures and think that the NHS has been properly funded. That is the real danger. Pretending that the funding has gone in allows people to say "It's just a bottomless pit. The Government have put in a significant amount of extra funding and we are spending as much as other European countries, but we are still failing." It is not the health service that is failing, but the Government: they are failing to be honest about how much is going into the health service.

Kevin Brennan: I speak not from a Back-Bench briefing, but out of personal curiosity. The hon. Gentleman rightly said that the Tories were considering the introduction of charging in the NHS. Will the hon. Gentleman confirm or deny that the Liberal Democrats are considering charging as one of the options for the NHS? Yes or no?

Evan Harris: No. I do not know what part of the word "No" the hon. Gentleman does not understand. I can tell him that we will go into the next election with a commitment to fund the NHS in a fair way that leads to equitable provision of services. Charging is at least a policy, which is more than Ministers have, but it fails in terms of equity. It may provide extra funding in the short term, but it fails to pass the test of giving a long-term future for universal funding and ensuring equity of provision. Charging the sick and elderly to see a doctor is the sort of policy that the Conservatives may consider. I hope that they will reject it, although in a way, I hope that they will not do so. If the Prime Minister or the Chancellor of the Exchequer—or even both—suggest that Labour Members consider the option, they may do so. However, the Liberal Democrats have reached that point. We have looked at those options and rejected them on the grounds that I have set out. I am sorry if that is a disappointment to the hon. Gentleman.
	The question is this: if the NHS is underfunded, what is the appropriate way of funding it? It would be appropriate for an accountable, honest Government to say before an election how much taxes will have to rise, rather than to claim beforehand that they will not increase taxes and then come scuttling to the Chamber afterwards to admit that taxes may go up. An accountable, honest Government owe it to patients, pupils and passengers not to rule out the fairest way of raising those resources. That is what this Government did in an attempt to bribe voters with their own money by ruling out a rise in the fairest tax, which is a direct, open tax—income tax. Instead, they chose to raise revenue through stealth taxes, indirect taxes and unfair taxes.

John Redwood: I am grateful to the hon. Gentleman for giving way as he stumbles his way through his fascinating speech. Can he please tell the House whether the NHS is underfunded by 10, 15, 20 or 25 per cent.? He clearly feels that it is a big number, so can he tell us how big it is?

Evan Harris: Unlike the Conservative party and the Labour party, at election time we provide a costed manifesto, a menu with prices. For example, at the last election we pledged that we would raise the basic rate of income tax by 1 per cent., 1p, to raise additional resources—£3.1 billion, to answer the question that was asked earlier—for education. That does not mean that the money already included in Labour's spending plans would be burned by the Liberal Democrats in government.
	Whatever the Labour party says it wants to spend on education, we would have spent £3.1 billion more, saying to the electorate that we thought it was necessary and that raising income tax was the fairest way to fund it. That would have meant smaller average class sizes, a fairer way to fund student finances and more provision for nursery education. [Interruption.] That may not, as Labour Members say, be enough, but it is £3.1 billion more than they offered at the last election.

Glenda Jackson: The hon. Gentleman has slithered away from the issue of funding for the health service and taken the lifeline that was thrown to him by the right hon. Member for Wokingham (Mr. Redwood). He argues that Liberal Democrat policy is to view funding for the NHS in the long term, and that their manifestos are always costed on that basis. As the Liberal Democrats know from one election to another that they will never be in government, presumably they have already costed those manifestos. Perhaps the hon. Gentleman would therefore be good enough to tell us how much they would spend on the NHS to ensure long-term funding at a level that they feel is necessary—

Evan Harris: rose—

Glenda Jackson: I am sorry, but I have not quite finished. Will the hon. Gentleman also tell us where the money will come from?

Evan Harris: The hon. Lady bases her question on a fallacy. [Interruption.] I shall deal with both of her points. She claims that the Liberal Democrats will not be in government. Well, that was said in Scotland, and in Scotland we are in government and, with our partners in the Executive, we are funding our commitment to a fairer system of student finance and our proposals for free personal care. I suspect that if the hon. Lady allowed herself to say so, she would agree with those policies. It is wrong to argue that we make claims that we never have to fulfil in government.
	The Liberal Democrats are also the only opposition party to deliver an alternative Budget every time the Chancellor of the Exchequer delivers a Budget, so the hon. Lady will not be disappointed. I hope that when the Chancellor reveals his Budget proposals for funding the health service at the Dispatch Box, she will rise in her seat to thank us for publishing our specific alternative plans the day before. I look forward to that moment.

Geoffrey Clifton-Brown: Will the hon. Gentleman give way?

Evan Harris: No, I want to press on with my speech. [Interruption.] I think that the hon. Gentleman will agree that I have been generous. He will have a chance to speak in the debate, and the less time he spends trying to intervene, the more time will remain for the debate.
	The Government, in their panic, have introduced distortions to the health service, and they have done the same in education. The rigidity of maximum infant class sizes has led to disappointment for individual children but no more gains than would have been made by putting resources, which we would have increased, into lowering average class sizes. The Government professed that they wanted more students from poorer backgrounds to go into higher education and then introduced a policy, which they denied during the 1997 election, to make poor students poorer in the hope that it would encourage more of them to enter higher education. We see from the National Audit Office and the Government's own research that that failed and failed miserably. It led to inequity and it goes against what many people felt the Labour party stood for.
	On the health service, as the hon. Member for Woodspring (Dr. Fox) said, he and I and our predecessors pointed out the distortion of waiting lists. They can be cut by simply no longer offering operations, so when uncomplicated varicose vein operations were stripped out of the health service, it reduced the number of people on waiting lists at a stroke. The Conservative party must remember that it introduced the waiting list commitment, which the Labour party foolishly adopted. For the first couple of years, the Conservatives tried to hold Labour to a flawed commitment.
	The Government have done better with waiting times, but their fixation with maximums creates distortions in clinical priorities. Managers know that they will be marked—performance appraised—on the number of patients who have waited more than 15 months by the end of next March, regardless of how many intensive care unit beds they have to close to fund the maximum waiting time target and no matter how many patients who urgently need surgery have to be put off so that someone who would otherwise wait 16 months is treated in 15 to satisfy a political priority. The Government do not care, but patients will die as a result of those distortions of clinical priorities and their distortion of practice in A and E departments will have a similar effect.
	I pay tribute to the hon. Member for Canterbury (Mr. Brazier), who has done sterling work. His constituents recognise that he has been active in this area, perhaps more in opposition than in government, but Kent and Canterbury hospital in his constituency is so short of beds and so terrified of being accused of having long waiters that it has created a ward in a corridor by sticking to the wall a sign signifying "Bed station".
	People no longer talk about the old lady who has waited a long time in the corridor for treatment—there were five when I visited the hospital—because they now refer to the lady in corridor bed A or corridor bed B. That "Milburn memorial ward" is testament to the Government's failure to invest in dealing with delayed discharges. More than 1,000 operations could be done in East Kent, West Sussex and the Isle of Wight if they tackled that problem. If some of the money being paid out for patients from those areas, over the odds in secret contracts with private hospitals in another country, went on tackling bed blocking, they would get through many operations that they feel they need to get through.
	On the two-week wait for patients with suspected cancer, the shorter the wait the better, even though evidence-based studies show that it does not reduce mortality from cancer; but if the funding to implement that policy is taken from treatment budgets, people will wait longer for radiotherapy. Furthermore, as the hon. Member for Leominster (Mr. Wiggin) pointed out, people with confirmed cancer will wait longer for further investigation. Patients will die as a result of such a distortion of clinical priorities.

Jon Owen Jones: In answering my hon. Friend the Member for Hampstead and Highgate (Glenda Jackson), the hon. Gentleman drew attention to the fact that the Liberal Democrats are in government in the United Kingdom. They help to govern 15 per cent. of the population and they share responsibility for many of the matters to which he is referring. Why is he not claiming credit, if credit be due, for improved performance on the very waiting list issues that might arise in the areas of the United Kingdom in which the Liberals share power?

Evan Harris: Liberal Democrats.

Jon Owen Jones: The hon. Gentleman is concerned with the organisation's name. I am concerned with how long people wait for delivery of service. Why is performance not better, and perhaps worse, where the Liberals are in government?

Evan Harris: If the hon. Gentleman cannot get his words right, his point has little substance. We believe in devolution and therefore Liberal Democrats in Wales speak for themselves. At the Welsh Assembly, where they share power, they speak for the Administration. Good luck to them.
	The Secretary of State claims that the Liberal Democrats are not in favour of reform. Nothing could be further from the truth. We have proposals to reform the response to clinical negligence and move to no-fault compensation. We want to reform the way in which social services are funded and to allow more extensive and rapid multi-skilling for nurses. We want to strip out political targets for the NHS and provide proper, local democratic accountability and reform inspections of quality in the NHS. Those are radical reforms.
	I confess that we do not support pointless reform of the structure of the health service. That constitutes activity as a replacement for action. Patients and workers in the health service need another structural reform like a hole in the head.

Geoffrey Clifton-Brown: The hon. Gentleman has presented a long list of radical reforms that the Liberal Democrats would carry out in the unlikely event of their getting anywhere near governing this country. He has told us that the health service needs radical reform and that it is underfunded. He also said that class sizes are too large and that the Liberal Democrats would alter the way in which students are financed. He said that such financing can be provided only through a rise in income tax. By how much will income tax need to rise to pay for all that, come the next general election?

Evan Harris: At the next election, we will tell the hon. Gentleman and the country by how much income tax needs to rise to pay for our commitment to public services. At the last election, we were clear. We wanted £3.1 billion more for education, and in addition we had a proposal, which may appal the conservative Members on the Labour Benches, to tax people who earn more than £100,000 at 50p in the pound.

Howard Stoate: For the NHS?

Evan Harris: Yes. The hon. Gentleman will be disappointed by that reply. The money that the provision would have raised had two purposes. It would have given pensioners, especially older pensioners, a decent increase in their state pension. Not long ago, the hon. Gentleman defended an increase of only 75p. Our proposal would also have provided additional funding for training NHS staff. We had a costed manifesto; the Conservatives did not even have a sensible manifesto.
	However, we will support the motion. Although we have tabled an amendment to it, we will support it because it condemns a Government record that desperately needs condemning and because it says so little about Conservative policy. The less Conservatives say about their intentions, the less credibility they have. That matches the Government's lack of credibility, with their disgraceful record on our public services.

Jim Cunningham: I have a slight cold, so I apologise if hon. Members cannot hear me very well. I want to pick up the hon. Member for Oxford, West and Abingdon (Dr. Harris) on his comment that the Liberals would support the Conservatives tonight. In an article in The Guardian yesterday, the leader of the Liberal party—

Evan Harris: Liberal Democrats.

Jim Cunningham: Liberal Democrats, if the hon. Gentleman is so touchy about words. The article appeared to signal a change in stance. It suggested that the Liberal Democrats would not co-operate with the Labour party because the Labour party might not support proportional representation. That applied especially to the Prime Minister. What a price they charge for support! The article also suggested that further changes might occur. Perhaps the Liberal Democrat spokesman can explain some of his leader's comments in The Guardian. The article stated:
	"In a surprising announcement, Mr. Kennedy says the Liberal Democrats would not necessarily stick by their pledge to raise income tax to fund public services".
	I remind the Liberal Democrats that many people, especially in the trade union movement, are under the impression that the Liberal Democrats would support proper funding for public services and, if necessary, tax increases.
	The article continues by quoting the right hon. Member for Ross, Skye and Inverness, West (Mr. Kennedy):
	"'We might well go into the next general election saying that we favour lower taxes,' he says, though he insisted that he had no 'crystal ball' on what might happen in three and a half years time."
	If ever there was a change in policy, that is it.

Phil Hope: Let me point out to my hon. Friend another aspect of Liberal confusion.

Evan Harris: Liberal Democrats.

Phil Hope: Liberal Democrat confusion. They are touchy about what we call them. A "Liberal Future" pamphlet called "Pro Bono Publico—must the state always provide?", published only last year, stated:
	"Some already question the idea that the NHS can provide everything free at the point of delivery. Is it time to start making a charge for some . . . NHS procedures?"
	That is Liberal policy.

Jim Cunningham: My hon. Friend makes a good point. That provides a further clue. If the Liberals are thinking about going down the road of tax cuts, they might want to balance them by introducing charges. That is the clue that we are getting from them, signalling a change in policy.
	There is another problem, though, if we listen to the Liberal Democrats'—I had better be careful how I refer to them—spokesman. The hon. Gentleman described a number of conditions under which the Liberal Democrats would accept the private finance initiative, but many people outside the House—particularly those working in local government and the health service—think that the Liberals are against the PFI. They are not. If we listen to what their spokesman said, they will accept it, given certain qualifications.
	Since the 1997 general election, the Liberals have made much of the link between pensions and earnings; before the election, they pledged not to do anything about that, but after it, that changed. They keep moving the goalposts. At that election, the Liberal Democrats proposed to put 1p on income tax to fund education. We have put £40 billion into education and the health service in the intervening years. That is three or four times what the Liberals were proposing.
	I want to touch on one or two issues that seem to have been forgotten, relating to what we are doing for the national health service, that are important to the public. By 2005, we shall have 10,000 more doctors and 20,000 more nurses. We shall also have 100 new hospital developments by 2010—even the Liberals would accept that we have to programme not only our developments but our expenditure. In addition, 3,000 general practitioners' premises will have been modernised by 2004. Those are some of the positive provisions that the Government are implementing. In terms of capital investment, we have said that we will invest £7 billion. That is a considerable figure by any stretch of the imagination. If we add to that the investment from the private sector, it is a considerable investment in anybody's terms.
	The Tories mentioned bed blocking. Bed blocking is not new; it existed under Tory Governments. The reason for it is simple: there has always been a shortage of social workers. We have debated that issue over the years, and one of the problems that we inherited in the national health service is that often when elderly patients are ready to be discharged, they do not have a social worker to ascertain their needs. We have been addressing that issue; the Tories certainly did not do so.

Tim Loughton: Will the hon. Gentleman acknowledge that the shortfall between the amount spent on social services by local councils and the amount that the Government are paying is now estimated at £1 billion? That means that, in parts of the country, there are vacancy rates of at least 30 per cent. for social workers. The situation is far worse than it ever was under the last Conservative Government, which is part of the reason why the problem of bed blocking is now worse than ever, and getting worse.

Jim Cunningham: I reject what the hon. Gentleman is saying. I shall give him an example from Coventry in relation to investment in public services, including social workers. Coventry lost something like £600 million under the last Tory Government. If we multiply that figure up and down the country, we shall soon find that we have invested considerably more—although, I accept, not necessarily enough.
	On transport, it was the Tories who privatised Railtrack. I remember the debates on that measure in the House. The Tories, not this Government, are responsible for the state that Railtrack found itself in a couple of months ago, when we had to take action. Under the Tories, one of the big problems was that the railways were heavily subsidised. At the same time as subsidising the railways, the Tories took money from bus services. In debates such as this, hon. Members do not always focus on the vital service that buses provide in this country. People wonder why many people will not use public transport. The reason is that, under the Tories, there was not only a lack of road investment but a lack of subsidies. I remember the Tories' attempts to privatise the buses.
	The question of student grants has been mentioned. I remember the Tories losing their nerve: it was they who abolished student grants and set up the Dearing inquiry. They set up Dearing because they knew that they were approaching a general election, and we all know what happened after that. We should have had a consensus from the Tories after Dearing, but we did not get one and, as usual, they reneged on what they had pledged to do.
	The hon. Member for Woodspring (Dr. Fox) said earlier that he did not want to talk about what Tory Governments had done in the past. That is the usual argument that we get from the Tories. They want to go back to Pol Pot's year zero as though there had never been a Tory Government, only a Labour one. The Tories would cut some £50 billion from the public services and, as far as I can ascertain from the debate, although they say that they would do something totally different, they would return to the policies that they pursued for 18 years and which they have tonight tried to deny they ever pursued.
	My hon. Friends will remember negative equity, the 3.5 million unemployed, record interest rates, and the decimation of Britain's manufacturing base, particularly in the 1980s. But the Tories do not want to talk about any of that. Anybody who lived in Coventry at that time will remember the decimation of the car factories. Coventry used to be famous for its car factories. As I said earlier, not only was there a lack of investment in the NHS, but my hon. Friends will remember when the Tories cut the number of beds, cut the recruitment of nurses and training, and closed hospitals. Indeed, if I remember correctly, we even had crumbling hospitals and they failed to deliver on their PFI proposals.
	We had school closures. The motion before the House speaks of teacher morale. Nobody created lower morale among teachers than the Tories. I remember one Tory Secretary of State being heckled off the stage at a teachers' conference. The Tories are responsible for the low pay in education, whereas we are trying to put it right. On pensioner poverty, I remember sitting on the Opposition Benches when, Friday morning after Friday morning, one of my late colleagues presented a Bill for winter chill payments. Who talked it out? It was the Tories. At the 1992 election, they said that they would not increase VAT on fuel, but they did.
	In conclusion, I do not think that the Tories can attack the Labour party. We have demonstrated that we are taking the country forward and that the country does not want to go back to the bad old days of Thatcherism and Tory Government.

Kenneth Clarke: The hon. Member for Coventry, South (Mr. Cunningham) has sat down after making a speech that was entirely concerned with an extraordinary, rather rapid attack on the history of the Conservative Government. He said that a Conservative Government abolished student maintenance grants. I am afraid that either his memory has gone or his sense of history is failing, because they were abolished by the incoming Labour Government.
	The hon. Gentleman's approach, which is a pale echo of that adopted by the Secretary of State for Health, shows that Labour Members are simply not addressing the serious subject before us: the future of the public services. In my opinion, it is the only serious subject that is currently engaging the attention of most of the general public.

John Smith: Will the right hon. and learned Gentleman give way?

Kenneth Clarke: I shall give way once I have made a little progress—not straight away.
	We are in a curious political situation, largely because we have just had a general election and the Government have a huge majority, settling the government of this country for the next few years. A lot of the general public have switched off from the party political debate altogether: almost half of them refused to take part in the general election. The one thing that is bringing people back to politics—they will be brought back on other things—is concern about the state of our public services. I do not think that I overstate the case when I say that there is widespread public anger about that. It is easy to detect a national sense of shame about the standards that are being achieved in some of our public services when one reflects that the United Kingdom is one of the wealthier countries in the world.
	A source of much of the public's disillusion with politics, politicians and party politics is that they despair of the ability of the political process to produce the improvement in services that they wish. Giving a litany that could have been prepared for the 1997 election—which I shall not debate, although much of it was totally false—or indulging in the cavalier exchange of slogans about the past, which was all the Secretary of State for Health was able to produce, does not remotely respond to that.

Phil Hope: The right hon. and learned Gentleman comes to the House to lecture us about public services when has form in spades, which is a bit rich. I remind him that, when he was Chancellor of the Exchequer, the hospital-building programme came to a grinding halt, and as Secretary of State for Health he abolished free eye tests, so we will take no lessons from him. Does he support his party's view that it will not invest more in health services and will instead charge patients for services? What is his opinion on that?

Kenneth Clarke: I had two spells at Health and one at the Treasury. We hugely expanded the amount of money going into the NHS. We combined it with much radical reform, most of which is now grudgingly accepted by the Government.
	I have already said that the one thing that I shall not be drawn into is a ludicrous debate in which the Labour party tries to demonise the Conservative party's past. That is a grotesque caricature of our attempts to improve public services. Labour opposed every step we took, most of which it is now adopting.

John Smith: Will the right hon. and learned Gentleman give way?

Kenneth Clarke: I will give way and then proceed with my speech. I have one clear memory of the hon. Gentleman. He won a by-election in Vale of Glamorgan by conspiring with the local branch of the British Medical Association to say that my health reforms would involve paying to see a general practitioner. That was grossly untrue. We now have a pale echo of that, whereby the Labour party is trying to put it to my hon. Friend the shadow Secretary of State that he is contemplating charging and cuts in expenditure. I am aware of no such policy. I do not believe that any Conservative has ever put that forward as our policy on public services, and I do not think they ever will.

John Smith: My thanks are on record to the right hon. and learned Gentleman personally for letting me win that by-election in 1989, because it was a by-election fought on his reforms of the health service. But that is not my point. The right hon. and learned Gentleman said that this debate is about the future of public services. Neither the motion nor the opening speech by the hon. Member for Woodspring (Dr. Fox) made one reference to the future or to what his party would do instead.

Kenneth Clarke: I have already said that I want to move on to the future, yet I am faced with arguments from the past. I should have been interested if the hon. Gentleman had admitted after all these years that the proposition upon which he was first elected—that my reforms involved charging to visit a general practitioner—was false. It was not at any time contemplated. The hon. Gentleman's claim was a parody of what we were proposing, and fortunately the electors of Vale of Glamorgan were eventually able to realise their error and remove him.

John Smith: I am still the Member.

Kenneth Clarke: Does the hon. Gentleman still represent the same seat? Good grief. I do not know how he has the nerve to face those who first elected him, but I hope that they have seen through the absurd proposition on the basis of which he was first returned.

John Spellar: While the right hon. and learned Gentleman is still dealing with the past and before he moves on to the future, can he tell us by how much the national debt rose under the Major premiership, for a considerable period of which he was Chancellor?

Kenneth Clarke: Under the Major premiership, national borrowing continued to fall. During my chancellorship, the public sector borrowing requirement fell regularly. It dropped steadily. We were well on course to balancing the budget.
	The Minister has adopted the absurd habit of a Labour Government four or five years into office who continually present slogans and caricatures relating to the position that they inherited. He should come and listen to some of the exchanges between my successor as Chancellor and me. We sometimes have difficulty in disagreeing, because we have considerable regard for each other, but the point is that the present Chancellor on occasion concedes that he inherited an extremely good record from the last Government. It should be no part of a debate about the future of public services to keep repeating the bizarre claim that public finances were not improving, and improving rapidly, when Labour took over. We were then well on course for a balanced budget and healthy public finances.

John Spellar: Is it not a fact that the national debt rose from £175 billion to £350 billion—which is doubling in anyone's money—during the Major premiership, for a considerable part of which the right hon. and learned Gentleman was Chancellor? Does the right hon. and learned Gentleman accept that those figures are correct?

Kenneth Clarke: The Major Government, and I as Chancellor, tackled public finances in the teeth of opposition from the Labour party. We brought the public sector borrowing requirement under control, and at no stage did the national debt become out of control and unsustainable. When presenting unattractive Budgets, Labour becomes obsessed with taking credit for repayment of the national debt. As I have pointed out in the past, the present Chancellor managed that largely by accident rather than by design, having got his forecasts wrong.
	The fact that, in a debate on the future of public services, the Labour party is interested only in the history of the national debt represents a strange transformation; but I will discuss the national debt on a more suitable occasion, as I have already made my case.
	I believe that the crisis in the public services is, in most instances, considerably worse than it was when Labour took over in 1997. There were problems then, but they have undoubtedly worsened—certainly in the national health service, and certainly on the railways. Members who shake their heads or, even worse, try to respond by means of what I have already described as a cavalier excursion into the party politics of the 1990s seriously misunderstand the public if they do not realise that that is the feeling out there. If most of my constituents had been able to hear the speech of the Secretary of State for Health today on such an important subject, they would be deeply worried about the outlook for the country. It is time that we saw something more positive emerge from the debate.
	In their rare moments of candour, the Labour Government actually seem to admit that they failed to deliver in their first term. Their excuse is that they need another term in which to try to deliver. That admission, when it comes—and not a whisper of it has come today—does a little credit to the Labour Ministers who have been responsible for public services. It amounts to an admission of what I believe to be the case: that the Government were elected as a party with many promises, but no policies of any substance to deal with the public services about which they had been so vociferous when they were attacking us.
	The failure to deliver was not the responsibility of the civil service, which Labour's spin doctors usually blame when they are pressed. It was the bright young men who were brought into the Downing street policy unit who failed to deliver. A series of White Papers, initiatives and reviews have been produced, against a backdrop of declining standards in our key public services. That ought to be acknowledged, but it is plainly not being acknowledged.
	I agreed with one observation made by the hon. Member for Oxford, West and Abingdon (Dr. Harris) in his extraordinary and, in my view, entirely inadequate speech. He suggested that one thing the Labour party was doing following its latest change of policy—in some areas, particularly the health service—was grudgingly returning to the agenda of the Thatcher-Major reforms. There have been increasing echoes of the course on which we were set in recent ministerial pronouncements, or at least in the behind-the-scenes briefing that accompanies them. For reasons that are understandable if one looks at Back-Bench Labour Members, the Government are in a state of denial and cannot acknowledge that. The Secretary of State for Health had to exhume every cliché in the old Labour book to defend himself, when in fact he is anxiously looking up Conservative White Papers of 10 years ago to see where he went wrong and how he should start again. The next election in the Vale of Glamorgan will be dramatically different, given the Secretary of State's plans.
	However, the Secretary of State remained undaunted. At least he is resilient and can take a bold line to win over the House of Commons. He even dragged up the old argument about the Conservative vote against the establishment of the NHS in 1947. No old cliché was left unturned, but I suspect that most hon. Members present today were not even born when that vote was cast.
	It is downright foolish to assert that the Conservative party does not want to deliver better public services. Every sensible politician wants to improve them. The myths about cuts and charges are nonsense, and an attempt to detract from what really happened.

Tony Cunningham: rose—

Hilton Dawson: rose—

Kenneth Clarke: The obvious object of government, by any party, must be to improve the NHS, the education system and the transport network. I want to try out a few of the propositions on which any approach to the great public services of this country must be based.
	Experience shows everyone bar Liberal Members—or Liberal Democrat Members, as they are now, although the fact that the new party's proposals are as silly as the old party's used to be means that I am not greatly concerned about nomenclature—that the answer to improving public services does not consist solely in increasing funding. That lesson has been learned by every Government who have had to tackle the problem. Of course increased investment is needed, according to the capacity of the real economy to finance it, but everyone from the Prime Minister downwards in the present Government now accepts that a combination of finance and structural reform is needed in each and every case.

Hilton Dawson: rose—

Kenneth Clarke: That was what underlay the evolution of the reforms of the third Thatcher Government, and it is the agenda to which we all must return.
	He was not allowed to utter a word of it as he stood before his Back Benchers in the Chamber, but I thought that I had detected in some recent utterances from the Secretary of State the proposition that more diversity of provision was required, and that monolithic uniformity imposed centrally on a national level does not work. Why are the Government talking about specialist schools, for which the previous Conservative Government used to argue? Government briefings on education echo the words used in the argument on health.

Howard Stoate: rose—

Kenneth Clarke: I also believe that it is clear that the Government acknowledge the benefits of some competition in provision, especially in health. That competition is one of the benefits that arise when people have that most valuable thing—the ability to choose. The words were slipped into the Secretary of State's diatribe, but it is clear that the Government aim to give patients some choice about when and where they are treated in the NHS.
	That is only one example of a sinner come to repentance. The Government spent their entire first term trying to minimise such choice.

Howard Stoate: rose—

Tony Cunningham: rose—

Kenneth Clarke: I was hoping to establish a consensus, at least with the more loyal members of the Labour party. I shall finish my list of propositions, and then give way.
	The Government are also accepting, at last, that extra finance in public services over and above what comes from public funds must come from the private capital markets and from private finance.
	That sticks in the craw of most Labour followers and is not readily acknowledged by many Ministers but has plainly become central to the proposition. It has taken some time to convert them. All those are propositions to which the Prime Minister, Chancellor of the Exchequer, Secretary of State for Health and probably the Secretary of State for Education and Skills are being grudgingly converted. Far be it for me to help those right. hon. Members with their followers.
	One has to tackle management in public services. The Government seem to have bought that concept completely in the case of London Underground. At least I prefer their proposals to giving public funds and credit to the likes of Ken Livingstone and Bob Kiley. I do not like the Government's proposals either but a history of mismanagement—which London Underground certainly has—is often at the root of many problems.
	Private sector management often has skills that the public sector has never produced. It is astonishing that the Secretary of State for Health completely avoided mentioning one of the biggest revelations that has come to him in the past six weeks. He did not mention it even en passant because he knows that the dead wood behind him finds the proposition impossible to bear.

Phil Hope: Will the right hon. and learned Gentleman give way?

Kenneth Clarke: I am not finished yet. These are, I hope, consensus points. Localisation of responsibility for choosing priorities and making decisions is essential to great public services. It has taken the Government five years to realise that they cannot sit behind a desk in Whitehall listening to a lot of swivel-eyed young men from the party's research department and deliver priorities and targets nationally and monolithically. It has even been suggested that the role of Ministers has to change to one of monitoring and facilitating, but not to owning and micromanaging everything in east Kent, Oxfordshire and Nottinghamshire—as they have been trying to do.

Several hon. Members: rose—

Kenneth Clarke: Having made those unkind references to the dead wood behind the Minister, the least I can do is give way to one or two of them.

Howard Stoate: In the interests of consensus, I agree with the right hon. Gentleman about diversity. Surely he agrees that when his Government introduced a measure such as GP fundholding, they failed to ensure that practices that chose not to be fundholders got a fair crack of the whip. Some fundholders forged ahead in innovative ways but only at the expense of others. That bred deep dissent and resentment in the health service, which did a huge amount of damage. If the right hon. Gentleman had been more interested in consensus, we might have got somewhere.

Kenneth Clarke: I am delighted with the hon. Gentleman's acknowledgement that he agrees with some of my propositions. I am sure that the promotion he so richly deserves is at hand. I am glad to have done the hon. Gentleman a service by helping to further his career.
	We offered the possibility to all general practices to become fundholders, and we were going to lower the patient number threshold. We adopted the same principle used for NHS trusts in trying to get clinicians on board. All the hospitals that chose NHS trust status did so voluntarily. When local management was tried out, it became so popular that by the time we left office, all had changed to NHS trusts.
	GP fundholding was fought by the Labour party and the British Medical Association, so we looked for volunteers because we needed doctors committing themselves to making the system a success. Having taken the step of volunteering, they felt under a compunction to make sure that fundholding worked. It was spreading and becoming popular with most general practitioners. It would have become the norm and a universal provision but an ill-prepared new Labour Secretary of State—who came in on a few slogans and nothing else—committed the great mistake of repealing that innovation.

Tony Cunningham: I understand that for Conservative Members, 1997 was year zero—nothing happened before then and they cannot be blamed for anything. I will not concentrate on the past but will consider 2001—or year four, as far as the Opposition are concerned. In The Independent, the right hon. and learned Gentleman was quoted as saying:
	"This is electoral suicide. Five years before the next election, Duncan Smith is saying he will cut spending and force people to pay for NHS treatment."
	Does the right hon. and learned Gentleman still believe in that statement?

Kenneth Clarke: I congratulate the hon. Gentleman on making the first Labour intervention that has not referred to the past—indeed, almost no speech has referred to anything but the past—and on being the first to have the nerve to glimpse into the future. I do not think that the quote is wholly accurate. [Hon. Members: "Oh."] For the avoidance of doubt, I have repeatedly made it clear that I am completely committed to the national health service, which I do find an extremely attractive way of delivering health care. We must tackle the problems that are making it fail so badly at the moment.
	These debates, and Prime Minister's questions, get coloured by repeated assertions that the Conservative party is now committed to a policy of cutting public spending and introducing charges for health. As a member of the Conservative party I have never heard any of my colleagues put that forward as the party's policy. It is not the policy.

Martin Salter: rose—

Kenneth Clarke: I return to my consensus points, which no Labour Back Bencher has had the nerve to gainsay because they probably all wish to be promoted at some dim and distant time in the future. Given where we are now, the only reference that I will make to the past is to say that when we were introducing those propositions into public service, they were always described as privatisation. In election after election, not just the Vale of Glamorgan by-election, we fought a parody of the policies that we were putting forward. That continues to the present day to be the position of the Labour party because the speech by my hon. Friend the Member for Woodspring was greeted by an attack which, whenever it referred to what we were proposing, bore not the slightest relationship to anything that I had heard my hon. Friend say from beginning to end of his speech.

Martin Salter: rose—

Phil Hope: rose—

Kenneth Clarke: Let me make some progress if I may, because obviously others wish to speak and I obviously do not wish to continue to engage in further exchanges in which people try to attribute to the Conservative party policies and motives that are a myth, have always been a myth and are not what we are supposed to be debating today.

Hilton Dawson: rose—

Phil Hope: rose—

Kenneth Clarke: I have said that I will give way again soon, but I shall make some progress first.
	Having arrived at those basic propositions, Labour Ministers are having more than a little difficulty with them. One difficulty that they have to contend with is that they are finding it necessary to repair the damage that their predecessors in office did during the first four years of Labour Government. I cannot range over the whole field, but I probably give the Home Secretary the prize for being the Minister who is most rapidly disowning just about every policy of his predecessor in office from the same party. But the idea that the present Secretary of State for Health says a word that resembles any word ever uttered on the subject of health by the right hon. Member for Holborn and St. Pancras (Mr. Dobson) is fatuous. The current Ministers are finding it necessary to reverse policies, return to where they started and alter the agenda.
	Nowhere is that process more striking than on the question of funding. I have said that I believe that public services improvement depends on funding and structural reform, but the Liberal Democrats' arguments on funding must be addressed. The Liberal Democrats are the only people left, I hope, who will continue to mislead the public by trying to persuade them that the only debate that we need have on these issues is about who can spend more. That debate is characterised by sterile arguments in which party representatives say, "We spent more than you did" and arguments about who increased spending by how much in a given year. We hugely increased the resources going into health—and most of the other public services—over our period of office. The real question is at what rate resources should be increased. In answering that question, it is essential to bear in mind the real economy and the wealth of the country. The answer to that question represents the actual division between the parties.
	The Government did make one terrible error in funding in the first Labour period in office, about which I have always agreed with the more sensible Liberal Democrats. The first two years were a complete disaster and the funding arrangements that the new Secretary of State for Education and Employment and the new Secretary of State for Health accepted were a disaster from which both services are still reeling. [Laughter.] Labour Members are busily laughing, but they invented the completely bogus claim that they took over the previous Government's spending plans, which they most certainly did not. The only decision that the new Chancellor took and imposed on his colleagues was to cancel the anticipated annual spending rounds on which the Red Book had been based.
	Anyone who says that Labour did what a Conservative Government would have done is presumably claiming that, having produced a Red Book in 1997, we would not have had an annual spending round and that we would not have revised or increased the figures. As someone who lived through every annual spending round for 18 years, I can only say that we never did that for 18 years and, when we settled the Red Book in 1997, not a solitary man or women in office thought that we would not revise or increase the figures. The then Secretary of State for Education and Employment, my right hon. Friend the Member for South-West Norfolk (Mrs. Shephard), is sitting in front of me. I know her well, and if I had suggested to her when I was negotiating in 1997 that she would have to live without a change in those figures in 1998–99, she would have gone to the then Prime Minister and said, "Either he goes, or I go."
	That fatuous proposition was imposed on naive Ministers by a Chancellor who was desperate to show the City that he was tougher than I was and that he was the iron Chancellor. Well, he ain't tough now—he is pouring out money. We have had two lean years, followed by four years of plenty, as the Government try to restore the damage, but a public spending round is coming up and that rate of increase cannot be easily achieved. A bitter spending battle will take place in the next month between the public service Ministers and the Treasury about the next three-year cycle. The Chancellor hints that he cannot maintain spending without increases in taxation and the Prime Minister will not hear of any increase in taxation, so the Labour party's policy on funding the public services is not out of the wood yet—a large number of difficulties remain to be resolved.

Nick Raynsford: The right hon. and learned Gentleman is clearly in denial. May I just remind him that at a recent meeting that I had with representatives of local government, they contrasted the continuous increases in spending since this Government came to power in 1997 with what happened when the Conservative party was in government? They specifically referred to a meeting that occurred in the period that he has just described in which the then Minister for Local Government, the right hon. Member for Skipton and Ripon (Mr. Curry), came into the meeting and told them quite openly, "We have been stuffed by the Treasury." Would the right hon. and learned Gentleman like to recall the reality of those years and acknowledge that this Government operate quite differently?

Kenneth Clarke: If the present Chancellor is to maintain the level of health and education funding, he will have to stuff quite a lot of Whitehall Departments to avoid causing immeasurable damage to this country and raising taxation to an insupportable level. That is the job of a Chancellor. The right hon. Gentleman looks happy because he is responsible for local government, and the Government have taken the cap off local government spending and told those involved to go out and get the money through the community charge. I have to tell him, however, that the residents of my constituency are seeing the community charge increase year by year, beyond their capacity to pay. [Interruption.] I am in favour of capping local government expenditure, and in my opinion every party that wins government eventually gets converted to capping it, so I have not changed my mind.

Phil Hope: rose—

Kenneth Clarke: I shall not be diverted. Let me get back to my proposition, which, I am glad to say, no one has risen to challenge and with which one hon. Member rose to agree. What I described—it is a wonder of wonders, given what the Secretary of State for Health says—is a set of the basic propositions on which the Government will have a second go at structural reform of the public services, but they will have some difficulty with their own people, as has been made only too clear in this debate.
	I shall resist the temptation to gloat—welcome is any sinner who repents. I shall try to be constructive because it is important to realise that someone—it is more likely to be someone who sits on the Conservative Benches—has eventually got to deliver those propositions in a serious, joined-up and worked-out way. That includes, for example, depoliticising many of the key decisions that take place. That is why we privatised, why we brought in the private sector and why we tried to devolve.
	I always used to think it absurd that, whenever a site had to be chosen for new hospital, there would be a Conservative policy, a Labour policy and a Liberal policy in the locality on where the hospitals should be built. Whenever some new rolling stock needed to be ordered, one party had one proposition on where it should be ordered from and the other party went about it another way. That is an absurdity, and it is one reason why those public services for which Governments are most responsible are bedevilled. One has to allow patients' needs, pupils' and parents' needs, passenger priorities and the views of those who have responsibility for managing and delivering the services in the locality to have some freedom from the kind of political knockabout in which every Labour Member, including Ministers, who has spoken in this debate so far has found it irresistible to engage. Let me try to be constructive, but I am bound to be sceptical.
	My scepticism about the Government's ability to deliver has been strengthened in the past hour just by listening to Labour Members. I believe that I am right to say that they have been converted in principle to what I have said, but the conversion is more dramatic than that of St. Paul on the road to Damascus for most of those on the Government Front Bench. I can remember most of them sounding off when those propositions were first introduced to an extremely unwilling Labour movement, and they have not all been converted by their first four years of centralised planning, initiatives, spinning and re-presenting, and so on.
	What about the poor Transport Secretary? He—alas, poor soul—has not noticed that St. Paul has seen the light. No light has struck him. He is left—for a very short time in future, I suspect—wandering off down the same road, holding himself out to the Labour party as a hero who has renationalised the railway industry. However, the small print shows that he has not renationalised anything; he has just put the infrastructure company into a state of limbo for 12 months and made it more expensive and more difficult to raise the private sector capital that he needs. Only the Liberal Democrats are left with the policy of tax and spend and the reactionary old left agenda. A lot of Labour Members love to recall their old battles and wish that their party was back where once it was.
	Let me put some more flesh on the bones—which the Liberal Democrat spokesman certainly did not do for any of his proposals. Let me give some examples of why I think that funding is not the problem and how we shall make progress. First, the basic proposition that we have to bear in mind when listening to what the Secretary of State for Health says is that the purchaser-provider divide has been left in place. That is the key to the reforms; it sounds very technical, but it would have a very practical and very human consequence if it could be put properly into practice. The Labour party called it the internal market and used to denounce it. When the right hon. Member for Holborn and St. Pancras was Secretary of State for Health he used to claim that he had abolished the internal market, but, fortunately, he never did any such thing.
	The Government's proposition is now that primary care trusts—the successors to GP fundholders—will be responsible, they say, for disposing of 75 per cent. of this country's health budget by 2004. We are told that the PCTs will be given much more freedom, that they will be monitored and that their performance will be managed by the new strategic health authorities that are being put in place and will take over by April 2002. If the Government make that change without causing chaos and confusion, it sounds like a promising step back in the right direction. That is what the temporarily silent Labour Members call the internal market, and it is being taken further by the present Secretary of State than I was ever able to go—thanks to obstruction in the Vale of Glamorgan and elsewhere—when I was in office.
	One good thing is that at last the Government recognise the key role of primary care providers in the health service, which is always forgotten in such debates. One of the great strengths of the British health system is the general practitioner. A huge range of other people are involved in delivering primary and community services. The Government's proposal will do what we in the Conservative party always wanted to do—put the GPs back into the driving seat in relation to local priorities—so long as the Secretary of State generally lets go and allows them to do that. The proposal will repair some of the damage done by the abolition of GP fundholding—GP fundholding would have been better than the current policy, but let us proceed with what we have. I hope that Ministers can protect the proposal from the Treasury—Mr. Wanless and all—because it never likes such a degree of devolution. It likes central control and, as the Chancellor is working on his policy for the health service, I have a feeling that the proposal may run into difficulties.
	I am sceptical about the Government's abilities to deliver their promises for devolution given their position on the purchaser-provider divide, but I have some questions for them. How much genuine devolution of responsibility will there be? How much genuine competition and choice will they allow to take place? What incentives will they give to the Cinderella services and to prioritise the treatments that are required? The Government are made up of lifelong control freaks who are trying to put devolution into practice. On their past form, I do not think that they will succeed.
	How will the Government manage the confusion and overload that their repeated conversions have imposed on the system and that are causing widespread disillusion and despair in the service? They believe in permanent revolution. Even though this conversion may be one of the more desirable ones, they are handling the abolition of the health authorities, the setting up of the new primary care trusts and the negotiation of GPs' contracts with those who manage the service. There is a fantastic amount of overload and, if one talks to people in the service about it, one learns that their reaction is one of total despair that such a great deal of work is being thrown upon them.
	What about all the recent burdens imposed on people in the service and with which they are meant to contend while they carry out the revolution and introduce the new internal market by early next year? What about all the local modernisation reviews that they were asked to carry out last year? The NHS Modernisation Board is supposed to be supervising all that. What about contracts with Downing street? Only in December last year, the Downing street delivery unit set more than 100 targets and milestones for the service to achieve. What about the public service delivery targets that have been agreed with the Treasury and what about—heaven help us— Mr. Wanless, who only two or three months ago dominated the Chancellor's pre-Budget statement with a new blueprint for the health service? I am not sure that a great deal will be devolved.
	On 10 December 2001, an article in the Financial Times described the state of affairs that the Government have produced. It explains why I am sceptical about their ability to deliver devolution. The report states:
	"One senior civil servant said: 'Not even Margaret Thatcher when she got involved in the NHS review in the 1980s tried to micro-manage the NHS like this. Number 10 is involved in the day-to-day detail in a way that has never been seen before.
	Another added: 'The secretary of state is now doing the right thing by the service [in devolving power and responsibility], but Downing Street is doing the wrong thing by him.
	The Department is trying to protect the NHS from all this, and trying to reconcile the conflicts between the public service agreements and the delivery unit's contract.
	But if the going continues to be as tough as it has recently . . . then it is going to be very difficult to hold the line. NHS modernisation won't work if we revert to command and control.'"
	That was said just weeks ago and explains why the Labour party's conversion has not reached the point at which it will be able to deliver on its promises.
	I will not go on about the hospital service. The Government accept the private finance initiative, and more than 100 hospitals are being modernised or refurbished. That Conservative policy was opposed by Labour when it was in opposition. However, the benefits are now being delivered by this Government.
	The Government have even welcomed the idea of private sector management, but their approach to it is extraordinary. Private sector management is held up as a kind of punishment to be imposed on failing hospitals. The idea of giving more freedom to hospitals and providing them with a little more competition and choice is complicated by the ridiculous star system and the endless demand for streams of statistics, priorities and targets that Conservative Members have already said cause so much difficulty.
	For the first four years in government, the Labour party did damage and it is only just beginning to realise how it has to swallow every word it has uttered and to return to reform. It is like the Vandals and Huns who sacked Rome. They are now trying on the togas and trying to erect the pillars in the right place. However, as they all say different things on different occasions, they will not succeed. They must correct the public misconceptions about reform of services that they did a great deal to create.
	My prediction is that the Government will not succeed. They began this Parliament in the same foolish way as they began the last one. The Prime Minister immediately raised expectations that he has no prospect of delivering. He will not deliver them in this Parliament and he may not ever deliver them unless he undergoes a further considerable conversion on how to go about reform.
	A Conservative Government will eventually be able to return to their agenda and they will find that the political climate has been changed by the utterances of the past few months. Labour politicians will no longer be able to deny the basic tenets of reform in the way that they did in the past. However, at the present rate of progress, better public services of the standard that we deserve may take a generation to achieve. So far, the Labour Government have done more harm than good and I see precious little sign of real progress in the right direction.

Michael Foster: I am pleased to follow the right hon. and learned Member for Rushcliffe (Mr. Clarke) and to hear him refer to conversion, particularly his conversion to depoliticising decision making. I suspect that, when a former Chancellor considers the depoliticisation of decision making, it is because he has plans for a long-term career permanently in opposition.
	The test raised by the debate is whether there have been improvements in public services since May 1997, and that is the point that I will consider in my speech. I will describe what the people of Worcester have seen the Labour Government do since May 1997.
	In the battle against crime, police numbers have gone up. In the 12 months to September 2001, an extra 88 police officers were found for West Mercia and, just last week, a further 13 extra were allocated to the Worcester division from the crime fighting fund. The distinguished newspaper, the Worcester Evening News, proclaimed:
	"Thin blue line getting thicker".
	I accept that the West Mercia police authority has relatively few police officers per head of population. It is important in the battle against crime to see a greater and more visible police presence on our streets. Therefore I pay tribute to Chief Superintendent Simon Adams of Worcester division for his innovative work on Operation Terminate, which was specifically designed to put police officers in highly visible clothing into the city centre late at night when many disturbances take place. That helped to cut crime in Worcester city centre considerably.
	I said that West Mercia has relatively few officers per head but, since May 1997, funding for the authority per head of population has risen by nearly 22 per cent. That is against an average of almost 17 per cent. We are starting to make up ground, and my constituents and I are grateful for that. The chief constable of West Mercia wants an extra 100 police officers, and I support his view. I ask my right hon. and hon. Friends on the Front Bench to take note and to support the chief constable in his aims.
	Extra police officers are only part of the answer. In Worcester, a Home Office grant provided £640,000 for investment in closed circuit television. That will make the city centre and the car parks servicing the city centre safer. The system will be run from the brand-new police station that was opened by Her Majesty the Queen in March last year. A new police station, new closed circuit television and extra police officers are all contributing to the fight against crime.
	Antisocial behaviour orders also support the police in the battle against crime. However, I have to point to their non-use in Worcester. West Mercia has the highest rate of issue of such orders per head of population, but only one has been issued in Worcester. The Conservative- controlled city council, with its independent lapdogs, claims that the procedure is at fault and that this explains the failure to issue such orders. I disagree and, more important, so does the chief executive of Worcester city council, who wrote to me on 11 December 2001 to say:
	"The failure by"
	Worcester city council
	"to secure an ASBO cannot be attributed to procedural shortcomings . . . What we have not been able to do is allocate the resources which other Authorities have dedicated to ASBOs. Some training of staff has been undertaken but we have not got officers dedicated full time on this which is, I believe, the case in"
	neighbouring
	"Wyre Forest. Any ASBO work has been undertaken by officers in addition to their other duties."
	It is the lack of commitment by Worcester city council that is responsible for the lack of the issue of ASBOs.
	On the health service, much has been said in the House and outside about health care in Worcestershire. I do not intend to reopen old wounds as regards the debate surrounding acute services, but more nurses, doctors and consultants now work in the NHS in that county. They deserve our full support and our help in tackling the challenges that face us. Waiting lists and waiting times are falling, but I accept that there is much more to do before we have a national health service that we want our constituents to thank us for.
	The House has a long history of listening to Worcester Members of Parliament who want assurances on the future of the new district general hospital. The people of Worcester have been on a promise for more than 40 years regarding a new hospital. The Conservative Government promised, promised and promised again to build the new hospital, and they failed to deliver. They introduced the private finance initiative, and failed to build a single hospital. In the 1997 general election, I supported the PFI as a way to build Worcester's new hospital.

Kenneth Clarke: To be fair, Worcester's new hospital was one of the principal objectives that we had in mind when we developed the PFI, and we had advanced discussions on that. New hospitals are not built in four years flat. Worcester has a new hospital because the plans that began when I was in office and the Conservatives were in government came to fruition in Worcester. It is absurd to pretend that that was suddenly invented after 1997.

Michael Foster: The manifesto platform on which we stood for election was to reform the PFI to make it work. I well remember Conservative health spokesmen saying in that general election that Labour would not deliver the new hospital. We said that we would, and I am pleased and proud to say that in two months' time patients will start to move from the Victorian building that is Castle Street and the second world war Canadian army hospital that is Ronkswood into a new hospital that will be the envy of the country. It is just short of four years since the first sod was cut by my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson). The hospital has been delivered on time and it should be seen as a model for the way in which health care will be delivered.
	Two years ago I was pleased to participate in the launch of a new CT scanner for Worcester's hospital, which represented a £400,000 investment, paid for by the NHS. It replaced the CT scanner that was bought in 1988 which was financed by public donation. In 1988, begging bowls had to be sent around Worcester to collect money to pay for a vital piece of health care equipment. That is another example of the difference between the Conservative party when it was in power and the Labour party when it is in government.
	I like to think, as a former member of the teaching profession, that I have a great understanding of education. I pay tribute to teachers and support staff for the improved results in our schools since May 1997 at key stage 1, key stage 2 and GCSE level. Worcester has always benefited from consistently good A-level results at Worcester sixth form college and Worcester college of technology. More than anything else, the Government are delivering higher standards for our young people. We are also delivering better buildings and a better environment in which pupils can learn and teachers can teach.

Chris Grayling: Is the hon. Gentleman aware of the concerns that are being expressed by head teachers and teachers around the country about the burden of bureaucracy that the Government have imposed on them? I hear that again and again when I visit schools. I do not think that I have been to a single school without that issue being raised. Can the hon. Gentleman really be confident that the Government's policies are doing the right thing for the education profession when our teachers are so frustrated with what they are doing?

Michael Foster: Before I was elected, I was a school governor at a high school in Worcester. I remember the head teacher's frustration at having to decide which members of the teaching staff to make redundant. It was not a case of facing the challenges of recruiting extra teachers and support staff to our schools. The Government are making a difference to educational opportunities for young people.
	Worcester college of technology has just bought the old police station in the town to provide more classroom space. Worcester sixth form college recently had a new teaching block opened by the Minister of State, Department of Health, my hon. Friend the Member for Redditch (Jacqui Smith), who was a former member of staff at the college. The education maintenance allowance, which is being piloted in Worcestershire, means that more 16-year-olds are staying on in our colleges. Their results are better, not only in terms of their achievements, but in terms of their retention rates. I am keen to see that rolled out across the country.
	University college Worcester has just had a £2 million sports hall built for community and student use. It will house national and international teams. Importantly, it plays a big part in a project, with which I am associated, to widen participation in education. It uses sport as the tool to get young people from disadvantaged backgrounds into university and on to the campus so that they get a taste of university life. In that way we raise the aspirations of young people in all our schools.
	The school system has undergone a remarkable investment programme in Worcester city. Let me give a few examples of the extra investment that has gone into capital infrastructure projects as a result of the new deal programme for schools. Elgar high school now has a lift for the disabled. Bishop Perowne school refurbished its craft, design and technology facilities. Perdiswell primary had all its warm air heating replaced. Cherry Orchard primary implemented a £75,000 project to refurbish its library. Christopher Whitehead high school completely refurbished its showers and changing rooms. Pitmaston primary, Dines Green primary, Redhill primary, Our Lady Queen of Peace primary, St. George's Roman Catholic primary, Cranhan primary and Ronkswood junior all received emergency replacement of their fire alarms and safety equipment which was necessary because of the state of their buildings.
	Pitmaston primary has replaced its mobile classrooms. Nunnery Wood primary has a new classroom extension and Gorse Hill primary has two new classrooms. Lyppard Grange also has two new classrooms and Northwick Manor is in the process of completing a three-classroom permanent replacement of mobile classrooms. Nunnery Wood high school is about to have two new science laboratories built. St. Barnabas primary will have four new classrooms completed later this year, and St. Clement's primary will have two new classrooms completed.
	Those examples are testimony to what is being delivered by the Labour Government. The acid test is what has happened since 1997, and we are seeing improvements. However, I must tell Ministers—I know that they are sympathetic to this—that there is concern in Worcestershire about revenue funding for education and the standard spending assessment. I am pleased that the Government intend to reform the SSA. The indicative increase in SSA this year of 6.1 per cent. is a record for the county. Worcestershire has never had an increase that large. I am delighted that we can make a real comparison between the increased investment in schools and the cuts that we experienced in Worcester in the 1990s. The legacy of underfunding in our schools is holding back educational achievement in our county, but it is not the only reason for a lack of achievement.
	In the early 1990s, when the right hon. and learned Member for Rushcliffe (Mr. Clarke) was Secretary of State for Education, we had a Conservative-controlled county council that was proud of its record of low spending. It boasted that it returned money to the Government and spent less than the standard spending assessment. That decision cost schools and pupils in Worcestershire nearly £50 million. I cannot remember whether the right hon. and learned Gentleman objected to the decision by the locally elected Conservatives—he may tell me—which ensured that Worcestershire did not have adequate nursery provision. Only now is nursery provision starting to be enhanced by the Labour Government's investment. All four-year-olds have places at nursery schools and, increasingly, three-year-olds have places as well, which will help us to deliver a better education service. The budget for adult and community learning was cut in the 1990s because it was discretionary expenditure. As a result of that cut, poor nursery provision and a low base of revenue funding, Worcestershire does not do as well as it should. With the support of the Government, I am determined to raise educational standards in the county.
	The debate about the state of public services should have taken place in the early 1990s, but Conservative MPs from Worcestershire kept quiet. If they were ambitious, they realised that that was in their best interests; if they held office, they boasted about the low funding of Hereford and Worcester county council. To them, value added, which should be a measure of educational standards, meant delivering average educational performance from below average funding. In government, the Tories were good at low spending and low achievement. We must guard against that in future and never ever let people in Worcestershire forget.

Chris Grayling: Could I take the hon. Gentleman back to a recent report by the Organisation for Economic Co-operation and Development, which praised this country for its pupils' educational achievement? I remind him that the pupils who were measured in that survey went through key stages 1 to 3 under the Conservative Government following the reforms that they made to the education system. Those results were a tribute to the achievements of pupils ensuing from the reforms. Does the hon. Gentleman recognise the contribution that the Conservative party's education reforms made to raising the standard of achievement and delivering an excellent result in an international survey?

Michael Foster: I am about to conclude my contribution, but I want to tell the hon. Gentleman that Worcester is a relatively prosperous city. We have relatively low unemployment and are classed as middle England, so much so that, in 1997, Worcester woman was seen as the archetypal person whose support had to be attracted if we were to win the general election. Does the hon. Gentleman expect five of 12 wards in the city to appear at the bottom of a league of 2,000 for educational achievement? The Conservatives should not be proud of that record; I am not proud of it, and I want it to improve.

Gillian Shephard: I am grateful for the opportunity to speak in this debate because, as has been demonstrated already, it has raised issues of enormous interest to both to the public and to the many dedicated people who work in the public services. I congratulate my hon. Friend the Member for Woodspring (Dr. Fox) on his success in securing an Opposition debate on these matters and on his introductory speech.
	The speeches so far have been of great interest. I pay tribute to the hon. Member for Worcester (Mr. Foster) for his obvious dedication to education in his constituency—his knowledge of the subject clearly comes from past experience—and for the little spiky touch that he put in, just reminding Ministers that all is not entirely well yet. I was entranced by the presentation of my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) of himself as a master of consensus; I never thought I would live to see the day. His description of our discussions on the funding of education in the final days of the Major Government was much more his line on consensus than that which he has been attempting to preach today. He may have had his tongue in his cheek, but he did not seem to elicit many consensual responses from Government Members.
	I may do better, but I am not certain that I will, as I wish to begin by making some fairly hard points. I hope that today's debate will help Ministers to grasp a number of important facts. There has been more investment in public service during the life of this Labour Government and the previous one, elected in 1997. Investment is not as great or as new as Ministers would have us believe. Their hyping of that investment, their exaggerated claims—"24 hours to save the NHS" and "Education, education, education"—and their announcements and reannouncements of extra spending have been so blatant that the public have stopped listening and do not believe a word of what they say about improvements to public services. If I were in government, I would take careful note.
	It would be nice if the Government began to accept responsibility for the fact that they are in government. Things that are happening now, especially in practice, must be considered their responsibility. I intend to describe some of those things. It is a little tiring for the public to hear Ministers continuing to try to visit deficiencies in the public services entirely on the legacy of previous Conservative Governments.

Bill Rammell: Given that, during 18 years in government, the Conservative party constantly referred to the winter of discontent, is not the right hon. Lady's criticism a bit rich?

Gillian Shephard: That is a rather off-the-wall intervention, but it gives me the opportunity to remind the hon. Gentleman and his colleagues that today's debate is about the record of his Government and what they have done. No Opposition Member will make any apology for drawing attention to those matters.
	I hope that Ministers will note that announcing extra resources, while at the same time making complicated announcements about earmarking and ring-fencing those same resources, apparently with no idea of how contradictory policies will impact on one another, is rapidly becoming a discredited exercise. The public's daily experience, particularly in rural areas, of those same public services, is so far removed from ministerial hyperbole that the Government should stop describing what is happening and try sampling it instead.
	As I said, more money has indeed been allocated to public services. However, little effort seems to have been devoted to making sure that services work: to ensuring that behind the flattering headlines there are genuine improvements that people experience daily and that policy intentions announced in one area do not cancel out improvements in another—in short, to ensuring that resource allocation is underpinned by practical and workable strategic thinking. Consequently, every time the public hear yet another hyped announcement, they say, "Where is the money going? We can't see the benefits for us." That is a relevant question for the public to ask, because it is their money.

Hilton Dawson: The right hon. Lady properly acknowledged that more money had been spent on the public services, but criticised Labour Members for hyperbole. Is she seriously suggesting that her constituents have not received any of the benefits of that extra public spending? Will she tell us what new public sector resources are available in her constituency?

Gillian Shephard: I shall most happily do so. Indeed, I shall be devoting my entire speech to that matter, so I hope that the hon. Gentleman will be able to stay and listen.
	In short, there is a mismatch between Ministers' claims and people's daily experience, and that is what I intend to demonstrate. Understandably, this debate has been majoring on the shortcomings of the national health service. I say to the hon. Gentleman that I intend to make some observations about the way in which it is working in my own rural area. However, local people are as concerned about teacher shortages, lack of school places and police funding as they are about the health service.
	Ministers' pronouncements on those matters give no indication that they have the remotest idea of what it is like to try to access public services in a rural area. Travelling from the village where I live to the nearest GP's surgery means making a round trip of 15 miles. Ministers say that they understand. Indeed, they produced a rural White Paper and countless quangos to try to demonstrate their understanding, but sadly, their policies still show no sign of demonstrating in practice that the lesson has gone home. The point is that rural sparsity has implications for the delivery of all public services. That is the case whether we are talking about the NHS, schools or the police.

Howard Stoate: I agree that there are difficulties with GP practices in rural areas. The right hon. Lady said that some of her constituents had to travel seven miles to a GP's surgery. What does her party suggest that we should do about that? The Government are increasing the number of GPs and investing in the modernisation of their surgeries. We are even investing in improved public transport links. What would her party offer that this Government are somehow failing to achieve?

Gillian Shephard: It is, of course, under this Government that the cost of motoring—the only alternative that is open to many of my constituents—has risen sky high. I ask the hon. Gentleman to remember that and to bear in mind the fact that, as I said, we are talking about the achievements of his Government.

Hilton Dawson: Will the right hon. Lady give way?

Gillian Shephard: No, not at the moment. I have given way a number of times and I shall certainly return to that point.
	Ministers should be congratulated—this is a consensus point that I draw to the attention of my right hon. and learned Friend the Member for Rushcliffe—on embracing the PFI principle, on the basis of which all £229 million worth of the Norfolk and Norwich hospital is being provided. It is a good Conservative principle. It has certainly delivered the hospital in good time and people in Norfolk would be delighted about it, were it not for the implications of the accelerated opening of the hospital. Its opening has been brought forward from March to now and has been marked by local press headlines such as "Disaster looms" and "Crisis talks over hospital beds shortage". I accept that some of those problems result from a combination of severe winter weather and staff illness, but it would be interesting to know why the opening has been brought forward from its scheduled time in March. Has that happened because of the requirements of the PFI contractors? If so, it might have been better for health managers—I assume that that must include Ministers—to avoid the problems of winter and illness, and keep to the timetable.
	It is a disappointment and a pity that the memory of Norfolk people of the opening of the hospital—after all, it was conceived and planned under the Conservative Government—will be accompanied by memories of the huge problems associated with the shortening of the timetable. Norfolk people are also asking whether the hospital will be adequate for Norfolk's needs. Access is one of their main concerns. I am delighted to see the Under-Secretary of State for Transport, Local Government and the Regions, the hon. Member for Plymouth, Devonport (Mr. Jamieson) take his place; he is right on cue. Ministers should be concerned, like the people of Norfolk, that only one access point to the new Norfolk and Norwich hospital has been planned. When the Minister visited Norfolk to celebrate the beginning of dualling on the A11 in my constituency—he was very welcome—I asked his officials to drive him past the site of the new hospital, so that he would be able to see for himself the problems of accessing it through a residential and suburban area. Activity is now under way on that front and I think that we are getting help from the Highways Agency, but to the people of Norfolk, it seems a bit wasteful to spend £229 million on a hospital that one cannot get to in a rush hour, especially because by definition in a rural area, easy vehicular access is an absolute requirement.
	The new hospital is one thing, but the knock-on effects of its provision are quite another. It would be interesting to know whether the hon. Member for Worcester, who described provision with regard to the new hospital in his constituency, is experiencing any of the same problems. The Wayland hospital, which is situated near Attleborough in my constituency, is to be sacrificed to help provide funding for the new hospital. This much-loved hospital, with its 70-plus beds and strong local support, is to close in April, despite the fact that its closure will mean that there is no community hospital provision in the whole of the southern half of the county of Norfolk. People will be expected to undertake a round trip of 60 miles to Norwich for community hospital care. In response to the hon. Member for Dartford (Dr. Stoate), I point out that that is not a policy that was born of a former Conservative Government. We wished to retain the hospital precisely because of the travel implications of its closure.

Michael Foster: Let me intervene to put the right hon. Lady's mind at rest on one point. The community hospitals serving Worcestershire have not been affected by the building of the new PFI hospital. Indeed, they are part of the strategy to allow acute treatment to occur in the new district general hospital. Patients can be treated there and move into community hospitals at a later date. In terms of the acute service reconfiguration, all the options under discussion included the building of a new hospital, because, quite frankly, it was 40 years overdue.

Gillian Shephard: I am delighted to have that elucidation from the hon. Gentleman. He and his constituents are much more fortunate than my constituents and me. It is an extraordinary irony that people are being expected to travel 60 miles for community hospital care. What are we talking about? No replacement facilities have yet been provided, and even when they are provided, there will be no local community beds, as was originally promised. Instead, the health authority is
	"exploring options for providing such beds in nursing homes".
	That is a deeply fruitless search, as I shall go on to demonstrate. An increasingly elderly population will be left having to travel scores of miles for services—where they exist. I cannot believe that that is the sort of improvement that has been so much vaunted by Ministers, but it will be the daily experience of people in my constituency and in Norfolk as a whole.
	As if to rub the problem in, during the recent crisis at the new Norfolk and Norwich hospital—I emphasise that it was a beds shortage crisis—the chief executive of Norfolk health authority, Neil Wilson, made this bland announcement:
	"There are a number of community hospitals throughout Norfolk. Some patients who also need further care after being discharged from the Norfolk and Norwich are transferred to community hospitals to continue their recovery".
	"But not in the southern half of the county, "he might have added", and nor can the pressure on the new flagship £229 million hospital be eased by care in the community provided by social services". That is why I began by emphasising that Ministers need to think out how one set of policies impacts on another: there can be unintended consequences.
	Liz Railton, the director of Cambridgeshire social services, is quoted in Public Finance this week as saying that the flagship hospital cannot rely on social services because the Government grant is inadequate. She says:
	"Social services spending is increasing rapidly, but neither central government nor councillors are matching the increase with their budget allocations. There is now . . . an annual £1 bn deficit between what is allocated in the spending round . . . and what local authorities budget for social services".
	In another example of micromanagement, the propensity of Ministers to set local authorities' priorities in social services, namely for child care, means that their own announced health policies are not working.
	What about residential homes? Two years ago, I initiated a debate in the House on the implications for bed numbers in residential homes of the Government's approach to uniform standards in those homes. I said then that although everybody supported proper standards in residential homes, they have already had to contend with the impact of the working time directive, huge hikes in fuel costs and cuts in social services. I added that having to cope with the uncertainty and confusion surrounding the Government's new proposals would drive many out of business altogether, with a devastating effect on frail and elderly people, their families and in turn the NHS, which would have to cope with the result. Oh dear, that has proved to be all too true.
	According to Laing and Buisson, also quoted in this week's Public Finance,
	"some 12,600 beds in care homes were lost in the fifth straight year of reduced capacity."
	That figure is significant because it is
	"equivalent to more than 10 per cent. of the total number of NHS beds. If people whose care requirements can no longer be met stay longer in hospitals, bed blocking will get much worse."
	Care home owners are not being paid their inflation costs, which are between 5 and 7 per cent., and receive instead an annual increase of about 2 per cent. That is why many are going out of business. Just as serious is the fact that, many are being redesignated as residential rather than nursing care homes precisely when the national need is for more nursing care in residential homes.
	We can add to those bleak facts the additional problems in rural areas—I look at the hon. Member for Dartford—where closures occurring under this Government mean more travelling for families and staff, less choice for residents and a greater concentration of jobs in towns. One is obliged to ask if Ministers meant things to turn out this way—or has their concern always been the slick headline rather than what is happening to people?

Julian Brazier: I am most grateful to my right hon. Friend for giving way in the middle of her powerful case. Given that it costs between three and four times as much to fund an NHS bed as it does a typical bed in a nursing home, does not the experience of an area such as mine, which has lost 15 per cent. of its nursing home beds in just 12 months, show that it is possible for a really incompetent Government to raise spending and lower standards of care?

Gillian Shephard: My hon. Friend's point is borne out by the comments of Liz Railton, who said:
	"The whole thing calls for a much more strategic approach, underpinned by financial planning".
	Ministers' commitment to spend more of people's money is being eroded by the fact that they fail to think through the impact of one set of policies and headlines on the delivery of other services.
	By no group is that more clearly perceived than by GPs. I recently did a survey of GPs in my constituency to find out their views on hospital provision and bed blocking. Their replies were very instructive for Ministers. Dr. Barton of the Campingland surgery in Swaffham replied:
	"We have never experienced so many 'Red Alerts' throughout the summer months, whereby we are implored to find solutions other than admission to hospital. The closure of beds was due to a lack of trained nursing staff."
	I hope that Labour Members noted his use of the word "never"—his comments apply not to a Conservative Government but to this Government. He continues:
	"While we welcome the new Norfolk and Norwich University Hospital, there will be fewer beds than at the existing hospital. We find it difficult to believe a lower number of beds will improve an already difficult situation."
	Many of his patients would agree.
	Dr. Grace Barlow of the Necton surgery wrote in December:
	"Of great concern to us in General Practice at the moment"—
	not five years ago but now—
	"is the apparent shortage of acute beds within the local hospitals. Although we have in no sense moved into a 'winter pressures' situation, both the Queen Elizabeth Hospital, King's Lynn and the Norfolk and Norwich Hospital have been on red alert and closed to all but the most urgent cases on a number of occasions recently. Even when there has not been an official red alert, on a number of occasions when seeking a medical admission for a patient we have been told that there are no beds in the acute admission ward and the patient has had to wait in Casualty, often for a considerable number of hours.
	Having now worked in the Health Service for over 25 years, l am deeply saddened by the erosion in the level of care that I can provide for my patients . . . I would be delighted for any pressure you can bring to bear in Parliament to rectify this situation."
	Well, there is fat chance of that, but it is worth reminding Ministers of their responsibilities in these matters.
	Dr. Young of Watton says:
	"We feel that bed blocking is the result of insufficient beds and is just part of the general difficulty of providing treatment in the secondary sector. There needs to be a system for discharge from acute hospitals into intermediate care—which would probably require additional hospitals, or the development of existing hospitals in this sector."
	Those are the views of GPs in my constituency, and they contain small comfort for Ministers. It is, perhaps, not strange but a little sinister for them to find, at every hand's turn, that professionals and the public seem more aware than they do of the effects of quick-fix headlines combined with a lack of strategic direction.
	Most recently, the pressure of population increase locally has caused one surgery to announced the complete closure of its facilities in Brandon. That will affect many hundreds of my constituents in the nearby villages of Weeting and Hockwold. On 14 January, Mr. Tunstall of Weeting, in an interesting letter, wrote:
	"After watching our globe trotting Prime Minister in an interview with David Frost I thought I would take the opportunity of writing to you to express my concern about the general state of our country's facilities.
	Mr. Blair and his colleagues certainly seem aloof and out of touch with the basic problems and wastage in this country including the Millennium Dome, Wembley Stadium, Railways, Education, NHS Structure, the Police Force"
	and so on. I wish that Mr. Tunstall were here because I think that if he were a Member of the House, Ministers would be having quite a rough ride. He encapsulates perfectly the views of the millions who experience daily the mismatch between what Ministers say and what they, the public, see.

Kevan Jones: The right hon. Lady has given us a snapshot of her constituency. In my constituency, for 18 years under her Government the GP in the ex-mining village of Craghead held his surgery in a terraced house with a leaking roof. Last week, he moved into a £250,000 purpose-built facility provided by a Labour Government. That snapshot of Durham is certainly not the same as the picture that she is trying to paint.

Gillian Shephard: I am delighted to hear of the good fortune of the hon. Gentleman's constituents. He speaks as he finds. So do I, and so do my constituents. It is a matter of great mystery to them that they hear Ministers vaunting the improvements in the NHS and other public services made under this Government while their daily experience is a surgery closure. Frankly, while one would not want a leaky roof on a doctor's surgery, that is better than no surgery at all, which is the experience of my constituents under this Government.
	Ministers have been approached by dentists from my constituency and they will have received a letter dated 31 December 2001 from Mr. Carmichael of Downham Market. His practice has served that area of west Norfolk since the mid-1940s and he recently lost one of his associates. As a result, and despite six months of expensive advertising, he has had to
	"deregister over 3000 patients and reduce staffing and it is unlikely that these Patients will find another Dentist."
	Of course, dentist problems are not new. We too had difficulties in government, but under this Government 3,000 patients have had to be deregistered and they will not find another dentist. Given Ministers' hype, the public could be forgiven for wondering why that little problem was not solved in the 24 hours left to save the NHS. Either way, for people on the ground the problem is gross.
	It is a pity that no Health Minister is here, but, in passing, I draw it to the Minister's attention that I made an innocent inquiry of Norfolk health authority to discover how many bodies are responsible for administering health in my constituency and in Norfolk. In 1987, there were four or five. There are now 16. Each has a chief executive, a glossy annual general meeting report, a chairman, travel expenses, premises—everything. Of course, that represents but a flea-bite in the overall NHS budget, but these things too are noticed by the public.
	Turning to education, in no other field have expectations been so raised and exaggerated or so dashed. Consider the daily experience of parents and teachers in Norfolk. In my constituency a year ago, it was revealed that a head was regularly teaching classes of 94. That was disavowed by Ministers and the Labour-controlled local education authority. Alas, it was the case, although it is no longer. That scandal was drawn to my attention by the parents, who said, "Why are they going on and on about class sizes of 30? We have 94 in ours."
	I also draw Ministers' attention to a letter to me dated 10 December 2001 from Dr. Brian Slater, Norfolk's director of education. He states that 30 of Norfolk's 52 secondary schools are over-subscribed, which means that if people happen to move to a town in which one of those schools is located, their children cannot be educated in that town. What does that extraordinary situation mean for rural investment, jobs, economic regeneration, children and parents and the schools themselves? It means more expense for council tax payers, bussing out of the county for many pupils and the end of choice. Talking of strategic planning, how can that have happened after five years under a Labour Government and, up to last June, eight years under a Labour-controlled county council? These people's priority is "education, education, education", but do not try to get a child into one of those 30 secondary schools because he or she will not get in. Apparently, these paragons—these enthusiasts for education—did not notice planning permissions, house building and new developments.

Kevan Jones: Will the right hon. Lady give way?

Gillian Shephard: Not at the moment.
	It could be argued that, by definition, authorities have 11 years' notice of the need for a secondary school place, but that was not enough. The situation is without precedent in my 30 years' experience of the education system and it represents the most extraordinary lack of strategic planning. It is a marvellous example of the mismatch between ministerial claims about public services and people's daily experience, and the blame must be laid at the door of the Labour Government and the Labour county council.
	On police funding, my constituency was deeply affected by the Tony Martin case. In its aftermath, anxieties about the level of rural policing, the pointlessness of reporting crime when the police are so stretched and the fear of crime all surfaced only to be allayed by ministerial pronouncements on what would be done, but what we were told bears little relation to the chief constable's current perceptions. He has written to all Norfolk Members of Parliament to point out that there is a £162 million gap nationally between Government support next year and police need and that the Government propose a 3.6 per cent. budget increase in Norfolk even though the police authority calculates that it needs 4 per cent. just to stand still.
	The debate has been informative and it is illuminating to hear the experience of Members from both sides of the House. It is to be expected that Labour Members will find constituency examples, which are perfectly accurate, of course, to support their Ministers' claims. Alas, public perception has moved on and they are sick to death of ministerial hype, which often bears no resemblance to their experience.
	Ministers have only themselves to blame for the disbelief—or worse, cynicism—in the public mind over the state of the public services. Ministers make overstatements and exaggerated claims of improvement, but they have failed to grasp that there is a mismatch between what they say and what people experience. They will pay for it.

Howard Stoate: I am grateful to be called in this important debate, but I am disappointed with the contributions made so far, particularly those of Conservative Members, who have failed to grasp the opportunity to draw out important public sector issues. I for one was looking forward to hearing what the Conservatives have to offer for the public sector. It is no good shadow Minister after shadow Minister ranting on about how terrible things are. We want to hear what they have to offer instead.
	The right hon. and learned Member for Rushcliffe (Mr. Clarke) appeared to want a spirit of consensus and appeared to lead the debate forward into constructive areas, but, unfortunately, all he really wanted to do was defend his record and knock the Government yet again—on and on and on he went.
	I speak as the only practising doctor left in this honourable House and as one who has some expertise in the health service. There, as in so many areas, size does indeed matter. I shall not rehearse all the arguments made this evening, but it is impossible to defend the claim that the Government have not been funding the health service properly. Look at the figures: £49 billion for 1999–2000 and a projected £68 billion for 2003–04. That represents a real-terms increase of about 35 per cent., which must be the largest ever sustained increase in health service expenditure.

Chris Grayling: Has the hon. Gentleman considered the possibility that the Government may have increased spending, but delivered no results? On running the health service, has he considered the possibility that the Government might not be doing the right job?

Howard Stoate: Oddly enough, the hon. Gentleman is beginning to engage in constructive comment. Perhaps we should be considering that matter. I want to focus on the way in which we should deliver services. Sterile debates about putting a penny on income tax, which party would put the most money in—

Gregory Barker: Will the hon. Gentleman give way?

Howard Stoate: I want to make progress before giving way again.
	I cannot understand the point of such debates. We go round in circles, trying to score points off each other. For example, the Liberal Democrats say that they want to put 1p here and 50p there. It simply does not make sense to people.
	It is not only size that matters, however, but what we do with it. I want to consider reforms that the Government could introduce to improve the NHS and provide services with which not only hon. Members but the public are happy. We need to reform. Opposition Members have gone on and on about the Government's failure to deliver; they should suggest methods of putting that right. I want to try to tackle that.
	My right hon. Friend the Secretary of State made an interesting statement about the three Ps, and said that we believed in patients, pupils and passengers. At least that is a constructive way of looking forward, and it is different from Conservative Members' three Rs—rant, rave and rhetoric, which get us nowhere. Opposition Members spend too long talking through their "Rs" and too little time on methods of improving things.
	The NHS is a complex and convoluted organisation. It has taken 50 years of custom and practice to get where it is today. My right hon. Friend's leadership and vision is beginning to cut through that. The monolithic structure of the NHS is one of its problems because its size and complexity make it difficult to steer. The analogy with a supertanker is therefore apt. The Government have shown vision, determination and bravery in setting some of the units in the health service apart from others to ascertain whether they are able to provide services in a way that has not previously been done. That affords us an opportunity to find what can be provided. I welcome some of the pilot schemes that the Government are currently undertaking. They may show how far the NHS can go and the number of new initiatives that can be introduced.
	I want to focus on some comparators. This week's British Medical Journal contained an interesting article, which compared the Kaiser Permanente group in California with the NHS. The group is a non- profit-making health maintenance organisation, which serves a similar population to the NHS and is largely based in California, where it has 6 million members. The paper in the British Medical Journal considers whether anything can be learned from comparing the organisations. It states:
	"The per capita costs of the two systems, adjusted for differences in benefits, special activities, population characteristics, and the cost environment, were similar to within 10 per cent . . . Kaiser members experience more comprehensive and convenient primary care services and much more rapid access to specialist services and hospital admissions."
	The most important finding was:
	"Age adjusted rates of use of acute hospital services . . . were one third of those in the NHS."
	We talk about bed numbers as though they were the linchpin of whether the NHS can deliver, yet an organisation in America that covers a similar population and has broadly similar funding and pressures can somehow provide a service that uses only one third of the bed-day numbers per 1,000 people a year.

Chris Grayling: I am intrigued by the hon. Gentleman's reference to the work of Kaiser Permanente. Does he believe that it is right to explore the management of the NHS, and would he support Conservative efforts to think out of the box about health care in this country and consider solutions that could provide genuine options for it rather than sticking to the old paradigms?

Howard Stoate: Would that the comments about the Conservative party were true. What have we heard from Conservative Members about their vision for the health service? Nothing. We have also heard nothing from the Liberal Democrats. I was looking forward to a constructive debate on the health service because the people of this country expect nothing less from a Parliament of this stature on the world stage. Yet Conservative Members have simply ranted about the way in which we have spent less than they might have spent. I want a constructive debate on providing services.
	The Kaiser Permanente study bears close examination because of the much shorter bed stays and fewer bed occupancy days a year per 1,000 of the population. It invests far more money in primary care, information technology and communication technology to enable that to happen. It provides a seamless service from admission to convalescence. The Government and the NHS could learn from that. Rather than ranting about the differences between the Labour party and the Conservative party, we should consider improving the health service for people in this country and matching the achievements in other parts of the world.
	The conclusion of the paper in the British Medical Journal stated:
	"The widely held beliefs that the NHS is efficient and that poor performance in certain areas is largely explained by underinvestment are not supported by this analysis."
	That is a fascinating statement because it contends that underinvestment is not the problem. We recently heard that the NHS underspent last year. Throwing money at the problem did not solve it because structural difficulties meant that we were unable to spend the money that was given to the health service. Rather than concentrating on the sterile argument about cost, let us consider provision, types of services, improving efficiency, communication technology, wiring up GPs' surgeries to hospitals and wiring up hospitals to social services to ensure a seamless transition for patients through the service.

Gillian Shephard: If the hon. Gentleman looks at all the nods and smiles from Conservative Members, he will realise that he is bringing us dangerously close to consensus. I congratulate him on his constructive approach.

Howard Stoate: Those congratulations are unexpected and welcome. I am happy to accept consensus. We do not have to confine ourselves to a sterile, narrow debate, which upsets people, turns them off politics and damages us all.

Gregory Barker: I share the enthusiasm of my right hon. Friend the Member for South-West Norfolk (Mrs. Shephard) and I, too, welcome such thoughts from Labour Members. It is a refreshing change from the usual ideological rant on the NHS. However, the big difference between Conservative and Labour Members is that Labour Members constitute the Government. They have been in office for almost six years. When will people in this country experience an improvement in the service after Labour Members have grasped the idea that simply throwing money at the NHS is not the answer?

Howard Stoate: It is so disappointing to listen to Conservative Members. They have nothing to say on the subject. I offer them a chance to set out part of their stall and present their alternative policies, yet all they say is, "You've been in for six years and we're not getting anywhere."

Martin Salter: Perhaps I can help my hon. Friend, whose speeches we always enjoy. As an acting GP and health professional, perhaps he would care to comment on Conservative policy as set out on 12 November in a memorandum from the hon. Member for Arundel and South Downs (Mr. Flight), the shadow Treasury spokesman. It fortuitously landed on my desk and is now on those of many other hon. Members. It states:
	"The reforms, which we will be proposing, will end the NHS monopoly and will entail those who can afford it making some payment for healthcare services."
	What does my hon. Friend believe Conservative Members mean by that? How much will the sick have to pay under the Conservatives should they ever return to power?

Howard Stoate: I thank my hon. Friend, but he should look on the bright side: at least the memorandum set out a policy, which is more than we have heard from Conservative Members this evening. Of course, I disagree with it. It would be interesting to hear how much they propose to charge. Conservative Member after Conservative Member has refused to admit the existence of the so-called charges. One of their spokespeople admits to the prospect of charging, yet others refuse to own up to that. I wonder if any of them are brave enough to admit to the policy.

Chris Grayling: Kaiser Permanente, which the hon. Gentleman mentioned, is part of a health care system in which there is no NHS-style monopoly, as described in the memorandum, and to which individuals make a financial contribution. Has the hon. Gentleman not admitted that it provides better-quality health care than the NHS?

Howard Stoate: The programme fascinates me because it is a managed care programme that works on a non- profit-making basis and is therefore similar to our NHS. People contribute to it throughout their lives, and it is a pooled risk system. That means that few people in it need to buy top-up private health insurance because it covers all their needs. Even more interestingly, the Kaiser Permanente system does not allow specialists to work outside the organisation. No consultants rush off to the private sector to top up their incomes; they cannot do that. We could learn from that.
	I want to consider wastage. I chair the all-party group on pharmacy.

Oliver Heald: Does the hon. Gentleman agree that an important aspect of policy is blunder avoidance? One of the Government's great blunders is that they have ended up with massive bed blocking because they have lost 49,000 care home beds, which is something about which the Opposition warned them.

Howard Stoate: The care home sector is extremely important, but the hon. Gentleman fails to recognise that the net loss of beds in the sector is only 19,000—though of course that is still serious. The hon. Gentleman also fails to take into account the Government's policy of care at home and managed care in the community, which reduces the need for beds. He is right to say that we need to address the problem of so-called bed blocking, and to move people on through the system much more effectively. I get irritated when my local hospital has so-called blocked beds, reducing the flow of patients. Of course that is irritating, and we have to look at the problem. That is why I am proposing a system in which the patient pathway from entry to exit should be seamless, as has been achieved in the Kaiser Permanente system.

David Taylor: Is it not the case that, over this year and next, we are investing £300 million to tackle bed blocking head on, in a way never seen under the Conservative Government? That should allow at least 2,000 elderly people to leave hospital, rather than blocking beds while they wait for parts of their treatment to be completed.

Howard Stoate: My hon. Friend is entirely right. The Select Committee on Health, of which I was a member, carried out a study into reducing the Berlin wall between health and social services, and we were able to work with the Government to enable that to happen, and to allow shared budgets and the pooling of resources so that the unblocking of beds could begin. That has been quite successful. My hon. Friend is right to say that the £300 million being put in for that purpose will make a big difference. It will allow a lot more packages of care to be bought not only in nursing homes but in terms of care at home—which is, after all, where people want to be, with their family and friends.
	We have not concentrated on the problem of wastage of medicines. As I said earlier, I chair the all-party group on pharmacy. One of the reports that we considered showed that about £220 million-worth of drugs a year is handed back to pharmacists. If we assume, as is reasonable, that that is only the tip of the iceberg, the figure will probably be much higher. One report that we examined showed that about 50 per cent. of people did not take their medication precisely as prescribed by their doctor. There could therefore be enormous wastage in the system.
	I am pleased that the Minister of State, Department of Health, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), is on the Front Bench at the moment, because I know that he takes a great interest in this issue. I would like to see how the Government can work with the pharmacy profession to tackle issues of medicines management and medicines concordance in a way that would significantly reduce wastage. If my figures are even partly right, there is a significant amount of wastage of the £5 billion budget that the NHS currently spends on drugs each year. That wasted money could be put to much better use.
	I would like to see a scheme in which primary care physicians and nurses can work with pharmacists, and with patients, to ensure that patients take the appropriate medication, to check that that medication is being used appropriately, and to ensure that patients get the chance to discuss with their pharmacist and their GP exactly what they should be taking and when, thereby freeing up significant resources for other uses. There could be enormous benefits from that. My hon. Friend the Member for North-West Leicestershire (David Taylor) had a debate in Westminster Hall only this morning to discuss issues relating to pharmacy.

David Taylor: Ten per cent. of the almost £60 billion cost of the NHS is devoted to its drug budget. About 25 per cent of that £6 billion—£1.5 billion—is the cost of generic drugs. A review is under way to determine ways of driving down the cost of generic drugs, because too much of our investment in the health service is leaking out to inflate the already large profits of the pharmaceutical companies.

Howard Stoate: I thank my hon. Friend for his expertise. He has an interest in this matter and has been examining it closely over the last few weeks, during which time I have discussed it with him. These are exactly the issues on which we should be concentrating.
	We also need to find a way of freeing up far more resources into primary care. Working as a GP, I find that increasing the number of community nurses can reduce the number of hospital admissions quite dramatically. In my own practice, when we are fully staffed with district nurses, our admission rate to hospital is extremely low, and our ability to take patients back into the community after they have finished their treatment is extremely good. When there is a shortage of nurses in the community, however, our hospital admission rate goes up, and our ability to take ill patients back when they have finished their treatment is hampered. Such shortages make life much more difficult. I would like to see much more real work done to increase the number of community nurses and other support staff, so that we can keep patients at home, and in some way emulate the Kaiser Permanente system, under which the average bed-stay is about three days, as opposed to our average of about five.

John Redwood: Has the hon. Gentleman noticed how people are turning more and more to alternative therapies and herbal remedies? What does he think GPs and the NHS should do in response to that movement?

Howard Stoate: That is a very big question, and slightly off the subject of the debate on public services. The right hon. Gentleman is right to say that people are turning more to complementary medicines, which certainly fulfil a need for some. I have a lot of respect for people who carry out research in this field, and who are trying to find out which alternative therapies have something to offer. I have no problem with such therapies, and it would be helpful if GPs were better informed on some of these issues, because they could then explain to their patients which remedies might be of use. However, this is far too big a subject to discuss in detail in a debate such as this.
	We can improve the efficiency of the public services, particularly the NHS, if we can determine where the cost-pinching and blockages are occurring—for example, in accident and emergency, or in relation to discharges or waiting times to see consultants. If we examine those pinch points, try to develop alternative strategies to smooth them out, take advice, and examine information and studies of alternative health care systems throughout the world, we should be able to introduce a far more seamless care system in this country.
	I want to reassert that this is not just about money. Size matters, but it is not the only factor. It is what we do with it that really matters. The Government have made a brave decision to consider alternative ways of freeing up hospitals, PCTs and individual practices to provide different models of care, and to learn from and disseminate best practice. That is the way forward, and I am sure that, as a result, we shall see the genuine improvement that people in this country have a right to expect.

Peter Lilley: Thank you, Mr. Deputy Speaker, for the opportunity to address the question to which this debate enables us all to respond. It is the question that the public are putting to all parties, and to every Member of the House. The public want to know how this country can have world-class public services. They are puzzled as to why, despite the claimed—and in some cases, real—injections of additional money by the Government, those services appear to be getting worse in many sectors.
	The public are puzzled, and they want a thoughtful, reasoned answer from people in the House. They will be profoundly disappointed by the response from the Secretary of State today. They will not be pleased that his reply consisted only of negative, bad-tempered, partisan attempts to blame everything that is happening now on the past and on his predecessors. They have a right to expect something more reasoned, thoughtful and forward-looking from the Secretary of State, particularly as he has vouchsafed to the media outside the House his thoughts and inklings of his plans, which he failed to mention here today.
	I want to try to address some of those issues. I hope that I can claim some respect across the House for being not exactly partisan on this matter. My departure from the Front Bench and from the deputy leadership of my party was precipitated by a speech that I made on the importance of focusing on and improving public services, and the limited role that private enterprise would have to play in that process. That evoked anger and horror in The Times and other organs of extremism that now relish reflections of what I said when they are uttered by the Secretary of State for Health.
	Like my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke), I seek consensus, but I shall begin by spelling out a few facts as they appear to my constituents, based on their experience of public services in Hertfordshire. I shall focus on health in due course, but I shall start with education, and with the size of classes and the pupil-teacher ratio in maintained secondary schools in my constituency.
	I was worried about what appeared to be happening, which seemed to contrast with what I was hearing from the Government, so I tabled a question asking what had happened to the pupil-teacher ratio since I was first elected in 1983. The answer showed that the pupil-teacher ratio improved during the period in which the Conservatives were in office, but in the secondary schools of Hertfordshire it has deteriorated every year since the Government were elected.
	Class sizes have got bigger. A Government who told us that their top three priorities would be education have given us bigger classes, bigger classes, bigger classes. That may be partly because of the difficulty of recruiting teachers. Hertfordshire is a high-cost area and, despite the fact that our schools are attractive places in which teachers would generally like to teach, we have recruitment difficulties.
	I therefore tabled another question asking how many teacher vacancies there were in Hertfordshire. The Minister for School Standards came back with the figures, on the central definition that he used, and said that there were just 50 unfilled vacancies in Hertfordshire. I issued a press release to that effect and, to my embarrassment, the local newspapers came back asking, "What do you mean by this? There are far more than that." Indeed, the county council figures show that the actual number of vacancies is more than four times as high as that revealed by central Government. [Interruption.] The figure recorded and collected by officials at Hertfordshire county hall is 209, not 50, and they believe that that understates the position because it does not include temporary cover in certain circumstances.
	On transport—

Gillian Shephard: Before my right hon. Friend leaves the subject, can he throw any light on the reasons for such a discrepancy? He was enjoined by Labour Members to give facts, and he seems to be in possession of two kinds.

Peter Lilley: It could be that the Government's rhetoric is not accurate.

Several hon. Members: rose—

Peter Lilley: This causes such horror among the loyalists anxious for promotion that I must give them their chance.

Bill Rammell: Totally fortuitously, I happen to have information on teacher vacancies in Hertfordshire in my possession, because some months ago I was making a comparison between Hertfordshire and Essex, where my constituency is based. The definition of a vacancy has not changed. The figure for Hertfordshire in 2000 was 17, whereas in 1990 it was 216. Can we have some credibility and frankness on this issue?

Peter Lilley: I am sorry, but the hon. Gentleman's figures are as unreliable as, and rather similar to, those deployed by the Government.

Bill Rammell: They are from the House of Commons Library.

Peter Lilley: I am comparing figures given by Ministers with those given by county hall officials. I have got hold of the questionnaire used by the Government, and it applies a more restrictive definition than that used by county hall officials, which explains how it is possible to get the figures that the hon. Gentleman is deploying. The head of teacher recruitment came to Hertfordshire for a one-day think-tank seminar on how to recruit extra teachers, and he acknowledged that the figures used by Government generally across the country are only a third of the number reported to local education authorities. I am grateful to the hon. Gentleman for enabling me to elaborate a little on that point.

David Taylor: Will the right hon. Gentleman give way?

Peter Lilley: No. I now wish to move on to transport.
	We were told that Thameslink 2000 would produce more train services and thus ease some of the problems on the already overcrowded line from Hitchin to King's Cross and from Harpenden down the existing Thameslink line. The cost of the project has risen from £250 million when it was first proposed to an estimated £2 billion now, yet the Strategic Rail Authority, a Government-created body, which made this proposal, now admits that the £2 billion will not, as formerly believed, result in any extra services. There will not be a single extra train at peak hours down either line. It will allow those trains to go further through London, and that is welcome. It will also make the service more attractive, but there is no point in attracting more passengers if there is not room for them on the trains because there are no extra trains to carry them.
	Although those facts have emerged during the public inquiry, the effective renationalisation of Railtrack has so bemused and paralysed management that they have been unable to respond to it or to produce alternatives, which would have given us a little extra capacity for the £2 billion worth of public finance that it is proposed to put into this project.
	As I said, I want to focus above all on health, so let me give a few facts about the situation affecting the NHS in my constituency. In 1997, we were told that it would take just 24 hours to save the NHS. Since then, I am afraid that in some material respects, things have got worse in Hertfordshire. There are now 60 vacancies for GPs in the county, and that figure has risen 20-fold in a year. The shortage of nurses has become so worrying that it has been necessary to close not just the special care baby unit but the maternity unit and the children's unit at Hemel Hempstead and transfer them all to Watford. We are awaiting the outcome of an inquiry, which may have reported to the Minister today, on whether that move will go ahead and, if so, whether it is likely to become permanent. If so, we fear that it may precipitate the undermining of Hemel Hempstead as a viable general hospital with its own acute and accident and emergency units.
	That problem springs from the current shortage of nurses and the difficulty of recruiting staff.

Andy Burnham: Given that it takes more than four years to train both nurses and doctors, surely those problems were created by the previous Conservative Administration and can be nothing to do with the current Administration.

Peter Lilley: The Government have been in power for more than four years. More importantly, there is in this country a substantial number of nurses who are qualified but not working in the NHS. There is therefore a vast pool of nurses from which recruitment could be made. However, rather than doing that, the Government have often recruited from the Philippines, as has been done for units elsewhere in Hertfordshire.

Andy Burnham: Will the right hon. Gentleman give way again?

Peter Lilley: I have already given way once. The hon. Gentleman has done his duty by his Whips.
	We then have the issue of waiting times. In 1997, the national figure for the proportion of patients waiting for more than a year was just over 2 per cent. Now in Hertfordshire, it is three times that proportion. Although improvements have been made in some areas during the 50 years in which the health service has been in existence, on a number of key issues things have got worse. The broad move forward that we were promised has not happened in the NHS and people are worried about what is happening.
	The Government's response is to promise more money, and then to go on promising more money in the future. They have set a target that this country should raise spending on health as a proportion of national income to the European average. That is an absurd target to set. Surely one should set a target—I hope that my hon. Friends will agree that this is their ambition—to match or surpass the standard of care achieved by comparable countries, not simply to spend as much money. Anybody can spend money without necessarily achieving improvements or higher standards.

Hilton Dawson: Will the right hon. Gentleman give way?

Peter Lilley: I shall give way in a moment.
	When my right hon. Friend the leader of the Conservative party illustrated that point, the Prime Minister had no response to it. My right hon. Friend said that Scotland, Wales and Northern Ireland already spend a higher proportion of GDP on health than the continent spends, which is the target that the Government want to attain. Does anyone pretend that the quality of care, of health outcomes, in Scotland, Wales and Northern Ireland is one that we should seek to emulate and universalise across England? Does any Labour Member say that his or her ambition is to make the English health service as good as the Scottish health service and no better? None of them does, but that is the Prime Minister's ambition. That is why we believe that the answer does not lie just in spending targets.
	The problem with the NHS, now and in the past, is that it is too centralised; Labour has made it even more centralised. Again, in my area, one sees that. The Government have taken away the right of the patient and GP to choose which hospital to go to. My area is surrounded by five general hospitals. We used to be able to choose which hospital to attend, despite some obstacles, but we can no longer do so.
	Instead, the Government gave that responsibility to primary care groups. They then merged primary care groups into bigger primary care trusts. They merged the four health authorities in Hertfordshire in twos, so that there were just two. Those were merged into a single one for Hertfordshire. Now that is to merge with Bedfordshire. There is constant merger and increase in size. Across the country, about 95 health authorities are to be merged into 28 big ones.

Howard Stoate: May I inform the right hon. Gentleman that it was his Government who got rid of the freedom of GPs to refer someone to whichever hospital they liked? Following the 1990 health reforms introduced by the right hon. and learned Member for Rushcliffe (Mr. Clarke), I phoned up Guy's hospital because I had a patient with a very rare type of leukaemia. The specialist said, "Have you got a contract with this hospital? If not, we cannot help you." It was the only hospital in the area that could help. In the end, I won my case but it was the Conservative Government who ended the right of GPs to refer patients to where those patients wanted to go.

Peter Lilley: That is not the case. [Interruption.] I am sorry. What ended that practice was the circular that I have in my hand: circular 177 from 1999, which abolished extra-contractual referrals. The hon. Gentleman said that he achieved his aim in 1991—an extra-contractual referral.

Howard Stoate: In fact, I had to argue my case. A very kind consultant from Guy's said, "I will bend the rules for you." I had lost the automatic right to refer a patient with a very rare form of leukaemia automatically to the hospital of my choice. I had to move through a very circuitous route before I was able to win. I had to persuade the consultant to accept my case.

Peter Lilley: The hon. Gentleman cannot say that we abolished that right and he none the less achieved it. It may not have been as easy as he would like or as I will propose, but the practice was certainly abolished as a right by the circular issued in 1999. Since then, my constituents have not been able to choose which of the five surrounding general hospitals to go to.
	I have had deputations of surgeons and specialists saying that the problem of specialist care has been intensified and exacerbated by that policy change. That was repeated by the president of the Royal College of Surgeons, who said that it had seriously undermined the provision of specialist care of the kind that the hon. Member for Dartford (Dr. Stoate) mentioned.
	Centralisation has been going on in the health service under this Government, at least up to now. It has culminated in central Government specifying in micro-detail what hospitals and parts of the local health service will do. My local hospitals are set about 248 targets. That is an archetypal sign of Stalinist centralisation: the belief of the people at the top that they can micromanage by laying down directives from on high, which all hospitals have to meet.
	Nowhere in the modern world attempts to manage large organisations such as that. The lesson from most large organisations is that, increasingly, one should take the opportunity to delegate responsibility locally, to give much greater autonomy, to make much more use of flatter, leaner management structures and of the opportunities that modern management methods and information technology make possible. However, that has not happened under this Government.
	That is partly because the mindset of the left is to centralise; it believes in central planning and control. That perhaps explains to some degree what has been going on, but it does not explain why new Labour Ministers who thought that they had shed the centralising tendency, or at least who were open enough to recognise that it had been at fault in the past and who declared themselves to be free of it in the present, have been involved in centralisation: the attempt to control everything from the centre. It is partly because of that other aspect of new Labour Ministers: they are initiators. They demand an initiative a day or a week to get the headlines. The simple way to get a headline is to launch an initiative from the centre, which inevitably involves some central decision imposed on the people at the sharp end of the service. That is why all those ring-fenced funds have been established, all those targets have been set, all those central directives have been laid down—so that new Labour news managers can get cheap and initially favourable headlines at the expense of a much more centralised, rigid and inefficient health service. That is what has happened in the health service.
	I have been advocating a move in the opposite direction. I published a document, which is already going through its nth print run, called "Patient Power". I recommend it particularly to the hon. Member for Dartford, who did not remember accurately the history of how these things have come about.
	I have advocated that we return power, decision making and choice to patients and to the GP who advises them. That is the most important direction in which power should move. We should restore the right of the patient to choose which hospital to use, certainly for all normal operations; for more specialist procedures the choice will inevitably be limited.
	As I say, from 1999, that choice was removed by circular 177. It has meant that, instead of the individual patient making a choice, the local health bureaucracy, the primary care trust in most cases, enters into contracts with hospitals, and patients follow the money rather than the money following the patient.
	It is important to enter into the history and to acknowledge that the problems have not always been recognised, even by my own party. Choice existed before the establishment of the NHS and was perpetuated when it was established. It was recognised that patients could choose whichever hospital they wanted, although normally they went to the local one, which was right and proper.
	However, patients should have the right, if they want, to go to a hospital with a shorter waiting list and to which the journey is shorter. They should have the freedom to go to a hospital that is nearer relatives should they want that. If they want to go to a hospital that specialises in the operation that they want, or has a particularly good record in it, they should have the right to choose that hospital, even if it means a longer wait than if they went to the local hospital. If they want to go to a hospital that they know has wonderful standards of cleanliness and care, they should have the right to opt for that. They may want one that does not have mixed-sex wards. For all those reasons patients may want to exercise choice, as they were historically allowed to do.
	Then problems began to arise with tighter budgeting in the 1970s and 1980s. All too often, patients chose, naturally, the most popular hospital. Therefore, the most popular hospitals ran through their budget before the end of the year, and it was the most popular wards and most popular hospitals that tended to close.
	That caused great perturbation among Members of Parliament in the early 1980s, and it was recognised that something needed to be done. Hence reforms were introduced by the then Secretary of State for Health in 1991. He gave GPs the right to be fundholding, which gave them greater flexibility, but where GPs were not fundholders and local authorities entered into contracts, the over-reliance on the contracting process—I accept the point—restricted choice and made it more difficult to exercise.
	Hon. Members can score points about that. They can say, "You got it wrong, so it does not matter that we made it worse."

Howard Stoate: Will the right hon. Gentleman give way?

Peter Lilley: No, I will not. I am being frank and honest and not trying to make partisan points. I am saying that not everything was perfect about the reforms. We should try to make them better, not worse. If the problem was that the system was based too much on contracts and not enough on money following patient choice, we should move towards a system in which money follows patient choice. That is what I want, and what I hope my hon. Friends will increasingly propose as an alternative.

Evan Harris: I have listened to the right hon. Gentleman with interest, and I think he is right in that abolishing extra-contractual referrals and renaming them contract service level agreements reduced, at the margins, even such choice as was available. Those were reforms introduced by a Labour Government who claimed that they would get rid of the internal market.

Peter Lilley: Indeed, and not only I, or politicians in general, have said it. No less a person than the director of the College of Health said of the directive that did abolish the residual right of choice through ECRs that it would mean patients' having "less choice than ever" in the history of the NHS. She was absolutely right, and we should go back to giving patients more choice. A precondition of that, however, is our giving patients and GPs facts on the basis of which they can make informed choices. There has been some progress in that regard, but I want to see more.
	I welcomed the announcement that information would be provided about the performance of individual heart surgeons. I hope we will learn from the example of the Americans, who ensure that such information is related to patients' pre-operative condition. That makes possible a much better assessment of surgeons' performance and ability. There should also be sensible discussion of what the figures mean. Mr. Yacoub, a surgeon who deals with the most difficult heart cases, may sadly lose more patients than someone dealing with minor cases; but everyone knows that he is the best heart surgeon, and will therefore be anxious to be treated by him. People are intelligent enough to use the information that they are given, so let us make more facts available to patients.
	Most important of all, let us make the money follow the choice. When a patient chooses a hospital, that hospital should be rewarded for treating the patient: it should receive the money it needs to provide that treatment. The more popular and successful a hospital is, the more able it should be to treat patients. Funding should not depend on how soon a hospital runs through its budget and has to close wards. We must also give hospitals more independence and autonomy, so that they can reflect the desires of patients without needing to respond continually to directives from on high.

Hilton Dawson: The right hon. Gentleman is making interesting points, some of which I agree with; but is he not missing the most fundamental fact of all? It is a commonplace among Labour Members that poverty underlies ill health. The right hon. Gentleman's Government did not face that fact—they hid from it—but this Government are prepared to confront it. Is it not the case that until the Conservatives are ready to face that uncomfortable truth, they will never have any credibility in terms of reform and improvement of public services?

Peter Lilley: I do not agree that the cause of ill health is poverty. Poverty is a bad thing: we ought to be against it, and try to get rid of it. Ill health is a bad thing, which often causes poverty, and we ought to try and get rid of that.
	I refer the hon. Gentleman to an article that appeared in the British Medical Journal on 5 January this year. It stated
	"Evidence favouring a negative correlation between income inequality and life expectancy has disappeared."
	According to the BMJ, the latest analysis of the figures suggests that there is no longer any attempt to pretend that inequalities in society create the problem of poor health. That, however, is not the central issue of the debate, and it is certainly not the issue on which I want to concentrate. I think we all agree that we want to get rid of poverty, regardless of its precise correlation with health.
	I have emphasised the importance of restoring choice, giving people information that will enable them to make informed choices, ensuring that money follows choices, and giving hospitals the independence they need to respond to those choices. I can give a constituency example showing how important that can be. As I have said, the constituency is surrounded by five hospitals. One—I will not name it, because steps have now been taken to improve it—has the worst record in the country for treating patients after hip operations. One in six patients used to die within 30 days of their operations. My constituents had to go to that hospital, however, because the local primary care trust was contracted to send them there. Only when we exposed concerns about the figures did the doctors say "We knew, but we could not afford to change the contract because that would have destabilised the health economy". They could not make a marginal change; it was all or nothing.

Siobhain McDonagh: Will my right hon. Friend give way?

Peter Lilley: I am glad to be the hon. Lady's friend, and I will respond to the warmth she has displayed by giving way in a moment.
	Only if hospitals can respond to the choice of patients, and those patients are allowed to move if they want to, will changes be made. The change will usually be modest; even if the information is made available, we see no huge change in referral patterns. If that happens, however, there will be a sufficient change to induce hospitals to recruit surgeons who are more skilled in certain areas, and return others to performing operations at which they were particularly good. I now give way to the hon. Member for Mitcham and Morden (Siobhain McDonagh).

Siobhain McDonagh: I thank the right hon. Gentleman, and apologise for embarrassing him by calling him my friend.
	The right hon. Gentleman mentioned statistics relating to orthopaedic surgery in a hospital in his constituency. Is it not significant that the Government have introduced the Commission for Health Improvement? Is it not significant that local people do not have to worry about those figures, because they have been made public? Although the system is not perfect yet, I assure the right hon. Gentleman that it has brought confidence to people in my constituency who now believe that St. Helier's problems are understood. Would he care to congratulate the Government on CHI?

Peter Lilley: I have already welcomed the increased release of information. We began a process; it has been continued, and I welcome that unreservedly. I do not think that it was NICE that released the figures—[Hon. Members: "CHI."] Some Greek letter of the alphabet, anyway. Whoever released them, however, I am all in favour of it.
	I do not think we should pretend that everything the Government have done is wrong, or that everything we did was right; but, clearly, the Government's general tendency has been wrong up to now. I want to investigate the possibility that they are now beginning to move in the right direction.
	The Government's initial response to my proposals was to dismiss them. They said that choice of the kind I was advocating had never existed in the health service, and that it was nonsense to say that they had removed it. They then said the exact opposite—that they had not removed it, and that it still existed—until I pointed out that it had been removed. A Minister then said that, under my proposals, patients would be chasing around the country for shorter waiting lists. That is a bit rich, coming from a Government who are sending patients chasing around Europe—around the Mediterranean now, we understand—in search of hospitals with shorter waiting lists. Why cannot patients at least be given the right to go to hospitals that may have shorter or no waiting lists if they are prepared to do so, or find it convenient?
	The Prime Minister said that my proposals would lead to hospitals competing with hospitals. That is just a bit of silly rhetoric. No one wants to see anyone doing down another hospital; what we want to see is hospitals striving to satisfy patients, and to offer them the best care in the most convenient and favourable conditions. We certainly do not want people to slag off competitors in the way that the Government may have implied that they would.
	It seems that the Government are beginning to move in the right direction, at least in their rhetoric. Having spent four years centralising, they are now at least talking of decentralising. Having ridiculed the idea of patient choice, they have now said that heart patients who have been on the waiting list for six months—and who are still alive—will be allowed to go to another hospital elsewhere in this country, or even abroad.
	That is welcome. It is extraordinary that the Government have chosen to enshrine the move in a bureaucratic process that almost requires minders for anyone considered foolish enough to avail themselves of the choice, but the idea is right in principle. It is sad that it is so limited, and that it is available only to people who have managed to stay alive for six months while waiting for a heart operation. I should like the opportunity to be spread more widely.
	The Government have also said that they will encourage greater independence for some hospitals. Those that have met their 248 targets will be allowed to be independent of those targets. Those that have not met the targets will be required to remain in the system and will be threatened with the terrible possibility of private enterprise management, as has been mentioned before. Well, that will be the day. I would certainly welcome other management groups making available other services to people, with money following choice and standard costs applying to other not-for-profit hospitals, as well as to NHS ones.
	Is the Government's recent change of tack a genuine conversion? Will it be successful? I hope that it is genuine, but I fear that it will not succeed. There is something innate in the left-of-centre mind that makes it find centralising, regulating and controlling solutions more satisfactory than those involving delegation, individual choice and independence.
	By and large, Labour Members—on the Back Benches, but on the Front Benches too—remain centralisers genetically. All the Government have done, I am afraid, is to steal some Conservative rhetoric while retaining the Labour substance. They have spliced together our right-of-centre rhetoric with the left-of-centre practice that is in their genes. The result is a sort of genetically modified Government—a particularly dangerous and odious form of Government.
	However, I hope that I am wrong and that the Government are moving in the right direction. I am certain that my right hon. Friend the Member for Chingford and Woodford Green (Mr. Duncan Smith) is doing the right thing by examining what is happening in other countries and looking at best practice abroad. He is wise to take a measured and timely approach.
	I am pretty sure that, when my right hon. Friend the Member for Chingford and Woodford Green has completed his studies, he will conclude that other countries very often offer greater diversity of provision. They have local autonomy in management, more money follows patient choice, and patients have more opportunity to make choices. If we adopt elements of successful best practice abroad and incorporate them into the NHS, we will do more to improve the quality of health care and ensure more successful treatment outcomes than anything that this Government have so far done or promised.

Martin Salter: I should like to thank the Opposition for giving us the opportunity to debate public services. It is hardly their strongest suit, but they get to choose the subjects for Opposition day debates.
	I shall concentrate on three themes. I want to highlight what has been achieved in my constituency, to give my personal and very unspun account of my experience with public service issues, and to examine the Conservative party's lamentable failures, both in terms of performance and in terms of winning the political and ideological arguments.
	By way of introduction, it is worth saying that public services are a new concept for most Thatcherite Members of Parliament, whereas most Labour Members have practical experience of them. We have either worked in or delivered public services, as exemplified by the excellent contribution from my hon. Friend the Member for Dartford (Dr. Stoate). He spoke with authority, and commanded the House's attention.
	My record is more humble. I spent two years as the co-ordinator at the Reading centre for the unemployed. That centre, funded by Berkshire county council until it was axed by the Conservatives, provided welfare rights, advice and education, and training opportunities for unemployed people in my town.
	I spent nine years as a regional manager for a tenant-controlled housing association that delivered affordable homes and empowered tenants with a genuine say over the delivery of their housing. That is hardly a leftist, centralising agenda. In fact, I remind hon. Members that the principle of co-operative ownership is at the heart of the socialist movement and of the work in the 1830s of Robert Owen and the co-operative movement.

Chris Grayling: Will the hon. Gentleman give way?

Martin Salter: No Conservative Member would give way to me, and I fully intend to return the compliment until a later point in my speech—which, I assure the hon. Gentleman, will be considerably shorter than the 35 minutes of tedium to which we have had to listen from some Opposition Members.
	I also spent 12 years on Reading borough council, nine of them as deputy leader. I am proud that, even in the dark days of Thatcherism, we in Reading always put public services first. We have never been frightened to say to people that they cannot get owt for nowt. We have made it clear that people must pay and that, if they want a top-quality service, it will cost.
	As the right hon. Member for Wokingham (Mr. Redwood) will know, council tax levels in Reading are substantially higher than in neighbouring authorities. However, it is worth looking at the Labour council's electoral record. The right hon. Gentleman can only envy the record of the Labour party in comparison with his, in our respective bastions of power.
	Since 1983, Reading Labour party has not lost a single council seat. It took control of the council against the swing in 1987, and has won seat after seat since. A solid Conservative authority that had swept to power on a promise that it would cut rates was swept out of power after it cut public services. The Conservative rump now consists of three councillors, who are in opposition to 36 Labour councillors.
	My first message to my Front-Bench colleagues is to be bold and to stand up for public services. They must be honest with the public, as people will pay if they think that they are getting value for money and that the council or the public service provider is in touch with them and their aspirations.

David Taylor: Will my hon. Friend give way?

Martin Salter: I shall take one intervention from a Labour Member, and I am more than happy to give way to my hon. Friend.

David Taylor: I thank my hon. Friend for giving way, but does he not think that the right hon. Member for Hitchin and Harpenden (Mr. Lilley) was right in one respect at least? He has suggested that there is no automatic link between inputs and outputs, and that we should decouple resources from quality. Newspaper articles earlier this week showed that, despite the extra investment and costs associated with private education, the results achieved represented especially poor value for money. Is not that something that we should bear in mind?

Martin Salter: I thank my hon. Friend, but I remind him that I have been present for the whole debate. By the time the right hon. Member for Hitchin and Harpenden reached that point, I had lost the will to live. I am afraid that I am not able to comment coherently on whether what the right hon. Gentleman said was right or wrong.
	I turn now to public services in my constituency and in Reading as a whole. As I have said, standing up for public services is nothing new for us in Reading. However, it will not hurt to take a quick look at the state of public services in my constituency, especially in connection with health, education, crime and transport.
	Berkshire health authority has been allocated £528 million in the current financial year. That compares with a funding settlement in 1996–97, the final year of the previous Government, of just £278 million. There have been radical improvements in health service funding. Waiting lists now stand at 14,435, as against 17,452 in March 1998.
	I agree that that does not tell the whole story, and that there is a debate to be had about waiting lists versus waiting times, but those are measurable improvements. I am perhaps more proud that despite the high cost of living in Berkshire, the health authority has 60 more qualified nurses than it had in 1997.
	We are spending an extra £540 per pupil, compared with 1996–1997. The number of five, six and seven-year-olds in Reading, West in classes numbering more than 30 pupils fell from 636 in 1998 to 62 by January 2001. Eleven-year-olds have achieved record primary school results. Conservative Members did not seek to condemn the Government's education achievements. The feeling that I get on the streets and in my constituency surgery is that although there may be a long way to go in health and transport, the public recognise and appreciate the tangible improvements in the delivery of education policy.

Chris Grayling: Will the hon. Gentleman give way now?

Martin Salter: No, not yet. The hon. Gentleman must be patient. His time will come.
	There has been a fall in recorded crime in the Thames Valley, although a worrying increase in violent crime. At long last, we have started to turn the corner on police numbers. I will return to defects in current Government thinking on crime.
	Reading has seen the opening of the long-awaited A33 relief road—a capital project that stalled for years under successive Governments of different political persuasions. We are proud of providing free pensioner bus passes, which sets Reading apart from other authorities in the area. There has been record investment in road maintenance and the introduction of a popular night bus service. Real improvements have been made in my constituency and it would be wrong to contribute to a public services debate without highlighting them.
	Since 1997, there have been significant increases in major capital programmes. I noticed the exchange between my hon. Friend the Member for Worcester (Mr. Foster) and the former Chancellor of the Exchequer about the future of a Worcester hospital. The right hon. Member for Wokingham (Mr. Redwood) will remember the incessant delays in refurbishing the Royal Berkshire hospital. That project was on hold for nine years. One of the first decisions by my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) on becoming Secretary of State was to release £71 million of direct public funding. Ministers were non-ideological enough to recognise that in that instance, the private finance initiative did not stack up and they delivered for the people of Reading in a way that the previous Government had not.
	Private finance has worked—in particular for greenfield sites. While some of us are ambivalent about the wonders of the private sector—I wish that my right hon. the Secretary of State for Health would not smirk at me—I give my full support and backing to the PFI when it delivers a new psychiatric hospital on a greenfield site in my constituency, replacing the disgraceful, crumbling, Victorian facilities at the Fairmile asylum on the outskirts of Reading. If PFI works, more power to its elbow—but where it does not, direct public funding must be delivered.
	I am pleased to see in his place the Under-Secretary of State for Transport, Local Government and the Regions, my hon Friend the Member for Southampton, Test (Dr. Whitehead). As he is my office mate, that makes it easier to say that Reading needs funding for a third Thames bridge. I am sick and tired of operating in a town in which people wanting to travel from north to south to join the M4 have to drive through the centre of the capital of the Thames Valley. If someone wants to drive from Oxford to join the M4, they have to go through our town centre or rat-run through the picturesque village of Sonning to cross a single-track bridge—purely because we have been unable to break the deadlock between Berkshire and Oxfordshire councils. I hope that my hon. Friend the Minister is making copious notes and that a third Thames bridge will be a shopping list priority in the comprehensive spending review.
	We have won election after election in my town using the slogan, "You're better off with Labour". With economic prosperity, record low levels of unemployment, high wages, fantastic job opportunities and quality public services, that slogan has some resonance.
	I am not attempting to be consensual but in the spirit of the contributions by the right hon. and learned Member for Rushcliffe (Mr. Clarke) and others, I intend to be frank. I spent some instructive time on the parliamentary police scheme, which I commend to other right hon. and hon. Members. It taught me that the police service is in urgent need of radical reform. It must be the last public service in the country that still uses carbon-paper forms. I cannot believe that police officers work in an environment that can take them out of circulation for five hours to process a simple arrest. In these days of laptop computers and Psion organisers, police officers should be able to make an arrest, file the information down the line electronically and move on to the next job. Police reform is vital.
	Every Home Secretary in recent times has the scars on his back. Conservative Home Secretaries will remember the problems of trying to implement Sheehy and ending up implementing the worst parts of that report. At long last, we have a Home Secretary who is prepared to take on vested interests. I am confident that he will get support from all parts of the House.
	In my region, the cost of a two-up, two-down terraced house built for a railway worker or a factory hand at Huntley and Palmer costs between £120,000 and £140,000—£50,000 or £60,000 beyond the reach of a newly qualified police officer. A cost-of-living allowance is vital. London Weighting has had its day. I was working at Heathrow airport in 1979 and moved to Reading because, believe it or not, it was a cheap place to buy a house. Now it is one of the most expensive. The same logic that introduced a £6,000 cost-of-living housing supplement for Metropolitan police officers should be applied to other hot spots of high housing costs throughout the country. Areas of Cheshire, Bath and other parts of the country fall into the same category.
	I was disappointed at police reaction to the wholly sensible notion of street wardens. The Police Federation—perhaps the last redoubt of unreconstructed trade unionism, and I know a little about that—described street wardens as policing on the cheap. What absolute nonsense. How many police officers object to performing functions for which they are ill equipped by their training and which could easily be undertaken by active citizens? If street wardens are policing on the cheap, cannot the same be said of the neighbourhood watch CID? The police cannot have it all ways. I sense a mood change, with progressive elements coming to the fore in the police service. My message to my right hon. Friend the Home Secretary and other Front-Bench colleagues is that they should keep up the battle against the forces of conservatism because until they are defeated, public services can never be reformed.

Don Foster: I entirely agree with the remarks that the hon. Gentleman has just made. Will he go further and agree that we should be looking at other ways of breaking down barriers? I would love, and perhaps the hon. Gentleman would also love, to see traffic wardens taking on a wider role so that they, too, could keep their eyes and ears on what was happening in the area in which they were operating.

Martin Salter: With due respect, I should like to give that idea further thought. The idea of backing traffic wardens at this stage does not have active appeal to me, primarily because in Reading we have just privatised our traffic warden service and the wardens are, as one would expect with a market-oriented service, approaching the job with tremendous gusto and even ticketing war veterans on Remembrance day. Although my seat is not as marginal as it once was, the hon. Gentleman will forgive me if I do not join him in the love-in with traffic wardens. I suspect that he likes traffic wardens only because they wear yellow.
	On health, I share all the instincts and prejudice of my tribe when it comes to the involvement of the private sector. However, I can live with the private finance initiative if it delivers better and quicker services to my constituents. I have no problem with using spare capacity in private hospitals to deliver badly needed operations that avoid the need for people to wait in pain and discomfort. Those in the private sector are trained by the public sector, so they certainly owe us something.
	I warn the Minister of State, Department of Health, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), that the involvement of private sector managers in the delivery of a national health service needs to be proceeded with with extreme caution. Remember that the private sector has no magic wand. Look what happened at the privately run, privately owned and privately operated Portland hospital recently, with that dreadful dereliction of duty—something that the consultant said would never have happened in the worst-performing NHS trust. To quote the Prime Minister, which is always good at these times, the guiding principle must be:
	"What matters is what works."
	The same principle surely needs to be applied to transport policy. While the Secretary of State for Transport has won himself many friends among Labour Members by having the courage to take on the vested interests of Railtrack and Railtrack shareholders, I wonder whether we are at a halfway house for the future of the rail infrastructure. The argument that the Prime Minister made in the Chamber that we gave rail privatisation a chance has some validity. It was not top of our list. It was given an opportunity to work and it failed.
	I do not envisage that the City will run a mile if the track and infrastructure are taken back into public ownership with a guaranteed level of investment on which the private train operating companies can operate, with certain guarantees of safety and guarantees that certain standards will be met. After all, our private road haulage companies run on public roads and public motorways. I do not understand the Government's reluctance to go the final mile.
	I have a hint for my hon. Friend the Under-Secretary of State for Transport, Local Government and the Regions: he and his colleagues at the Department would be well advised to concentrate on and perhaps pick a few winners when it comes to transport policy.
	The failure of successive Governments to address the school run is incomprehensible. I took the trouble of digging out from the website the report of STAG—the school travel advisory group. The period of its deliberation was 1998-99; there have been many other such studies. That is yet another report that is long on analysis but, unfortunately, short on conclusions. Twenty per cent. of all morning peak-time congestion is a result of the school run, but have we anything to say about it?
	I am not necessarily saying that America is a wonderful model for the delivery of public services, but I am certainly in favour of the American-style school bus. It is easily identifiable. Parents feel secure about their children using it. It can penetrate the estates in a way that the ordinary public transport network cannot. I should like to see more radical, more comprehensive thinking at least to address the issue of school travel. In my town, which is one of the most congested in the country outside London and Birmingham, it is more than 20 per cent. easier to get around town during school half-term. I hope that other hon. Members with a similar experience will add their voices to mine on this issue. I am surprised that successive Governments have been slow to pick up on it.
	After being frank and honest about my own Government, it is worth taking a look at the Conservative record. If four and a half years is long enough for us to have made a difference—or is it five years?—18 years was certainly long enough, so let us have a brief look at the Conservatives' performance over those four key areas.
	In those 18 years, police numbers fell and crime doubled. The Government axed the police housing allowance, triggering one of the greatest recruitment and retention crises that we have witnessed in the Thames Valley police, which has been replicated in other parts of the country. You never had it so good under the Tories—if you were a criminal.
	In transport, we had the £6 billion rip-off that was Railtrack—£6 billion of public money stolen to fund a botched and barmy privatisation which even in the most optimistic circumstances was never going to succeed. Some people have been reluctant to blame privatisation for the causes of the Hatfield and Paddington rail crashes. Yes, it is not the whole story, but I refer hon. Members to Lord Cullen's report, in which he said in black and white that the fragmentation of the rail network caused by privatisation led to a diminution in safety standards.

Chris Grayling: Is the hon. Gentleman aware that the Cullen report says clearly that safety on the railways has improved since privatisation?

Martin Salter: The Cullen report said perfectly clearly that the fragmentation of the rail network led to a diminution of safety standards as a direct result of privatisation; one cannot have it both ways.
	Bus deregulation also took place under the Conservatives, following the passage of the Transport Act 1985. It had a bad effect on my town but a worse effect on many other communities where they were not able to keep the public transport network in public ownership. Bus journeys fell by 25 per cent. in that period; no wonder congestion has risen. There were cuts in spending on road maintenance in the order of some 13 per cent. We had 18 years of transport under the Conservatives. They were anti-car, anti-train and anti-bus. That just about gives them a full house.
	In health, the hospital building programme ground to a halt. The failed internal market created a postcode lottery in health care and there was a 25 per cent. cut in training places for nurses. We had a national health service starved of buildings, equipment and nurses but, inevitably, awash with accountants.
	In education, there were funding cuts per pupil of £60 per pupil over the last three years of Conservative Government; 500,000 five, six and seven-year-olds were being taught in classes of 30 or more; and higher education funding was cut at a rate of 36 per cent. per student between 1989 and 1997. We saw lower funding, larger classes, crumbling school buildings and LMS, which we all knew stood for not local management of schools but less money for schools. Even the most impartial observer would conclude that on the issue of public services the Conservatives have very little to say and have a pretty lamentable record.
	I want to turn to the Conservative party's political ideology and the failure not just to make a fist of political tactics, but to persuade the British public to accept its ideology and philosophy. Yes, we all remember the Ridley and Thatcher quotes. Nicholas Ridley's idea of local government was that councillors should assemble once a year and award the contracts to private firms. He even joked—ha, ha—afterwards that he would be prepared to pay those councillors more generous expenses. At the height of Thatcher's power and influence, that was the driving ideology behind the delivery of a local government, and it failed. Of course, Thatcher said:
	"There is no such thing as society."
	Well, I am pleased that certain changes are occurring in the Conservative party's mood music—I shall call it no more than that. Given the leader whom it has elected, I will need a lot more than mood music to convince me that there has been a change of heart.
	The last general election was notable not for the appallingly low turnout—although that should worry us all—but for the fact that, for once, we were able to make the argument for public services versus tax cuts, and the British people voted for public services. Ministers should remember that we have a mandate to deliver improvements in public services, and we should be bold about it.
	I believe that we are starting to see a sea-change of the kind that we saw with the 1945 Government, whose influence considerably outlasted their six years in office and fed through into the body politic and the political consensus that led to the fact that Harold Macmillan built more council houses than any Labour Prime Minister. It may be ironic, bizarre and macabre to hear the right hon. and learned Member for Folkestone and Hythe (Mr. Howard) say that tax cuts are now less important than improvements to public services, but that at least means that the Opposition are starting to dance to the Labour tune. They may not like that, but it is happening. They tried their policy of greed, tax cuts, "me, me, me" and individualism, and it has failed at two elections.
	In conclusion, I should like to thank the official Opposition for giving us an opportunity to showcase our policies and expose the deficiencies in theirs. I should like to end with some advice to Opposition Members, not from me, but from Peter Kellner in the Evening Standard. I say this in the context of the last opinion poll, which, if the press coverage is to be believed, will have put the Prime Minister several points behind the Leader of the Opposition. In fact, the Prime Minister is on 61 per cent. approval, compared with 15 per cent.—hon. Members will pleased to know—for the leader of the Liberal Democrats and 14 per cent. for the leader of the Conservative party, who has yet to make any impact on his own party, never mind the public at large. Mr. Kellner writes:
	"Another week, another fashion. Suddenly the talk is of a Conservative revival.
	However, seven days of clement headlines cannot expunge a decade of"
	disaster. He continues:
	"Much more needs to be done. Here is a five-point plan for the Tory leader for the rest of his Parliament.
	Break with the past.
	Arrange a public execution of your party's extremists."
	I am against the death penalty, but I would buy the video. He continues:
	Neutralise the negatives"—
	a tough job; most of them have been put on the Front Bench. The list continues:
	Make sure your party is as varied as the rest of 21st century Britain.
	Don't be deterred by people like John Redwood who said yesterday that the Tories should concentrate on public services rather than the social liberal agenda. These are not alternatives. You must do both."
	Lastly, he says:
	"Be patient. Millions of voters still have bitter memories of the last Tory government. These will take time to fade . . . Your ambition for the next election"—
	hon. Members should listen to this carefully—
	"should be more modest. The Tories would do well to gain 50 seats. That would take its total to 216. If you are bold and persistent in tackling all of the tasks listed above, then, with a little luck, your party could do almost as well next time as it did in 1945."
	I welcome the Tories to the Damascus. I welcome their conversion to public services; I do not necessarily believe it—they may have convinced the Tory press that they are now the party of public services, but it will be a generation before they convince the British people.

John Redwood: I have declared my interests in the register.
	When a governing party decides that it wishes to offer heartfelt advice to the Opposition, it is usually beginning to lose it in a big way with the British public. There was a sign of hubris in the remarks of the hon. Member for Reading, West (Mr. Salter). He certainly has a rather different view of local services in our part of the world from mine, although I am glad that there was a slightly veiled threat towards the end of his remarks about what may happen if he does not get the third river crossing, which is much needed, and the proper improvements in our health service, for which we have waited too long. Of course, he did not tell the House that Reading hospital was in the queue to follow the very large Milton Keynes project. That went through under the Conservatives and—sure enough and on cue—when it was completed, the NHS went on to carry out the Reading project. What has happened under the Labour Government would have happened under the Conservatives.
	I give the proposal one rather than three cheers. We need a new hospital, but it is a pity that many other health facilities are being closed at the same time. As my right hon. Friend the Member for South-West Norfolk (Mrs. Shephard) said, it is a pity that the new hospitals come with a reduction in the number of beds available and with a scale of development that means that there definitely will not be enough beds to meet local demand.
	The debate began with the most touching and interesting scenes that we have seen in the Chamber for a little while. Rather like Tweedledum and Tweedledee, the Secretaries of State for Transport, Local Government and the Regions and for Health were together on the Government Front Bench. They gave an exceedingly good impression of being great bosom pals—two peas in the pod—as they used to be in the early days of the so-called Blairite project. They were meant to be the two white hopes, at the cutting edge of a technological revolution, rising through the ranks until they displaced the Chancellor, the Foreign Secretary and all the other grandees whom the new leader had inherited.
	What a difference a year or two has made. If we are to believe the spin in the press, these senior figures of the Blairite project have come to two totally different judgments about where the project is going and about how much support it has from Labour Back Benchers.
	In the red corner is the Transport Secretary. He is trying to give the impression—good spinner that he is—that he is in the process of renationalising the railways on the cheap. In fact, he is trying to give the impression that he is renationalising them for absolutely nothing; he has reinvented renationalisation without compensation. I see that the hon. Member for Reading, West hopes that the Transport Secretary has done exactly that. The hon. Gentleman looks extremely perky but, if he has studied the small print—with this Government, we must always study the small print—he will know that there is a small snag: renationalisation is not on the horizon.
	The Transport Secretary is dealing with a private sector company that had begun to make good progress in investing and developing a better railway in the first five years of privatisation, and Ministers acknowledged that themselves until a year ago. The message was sent to the pagers of Labour Members who were meant to say that there had been a big surge in ridership of the railways, that passenger numbers were up by a third and that freight was up by 40 per cent. They all knew the figures and they trotted them out. They made good salesmen for privatisation. Then the position changed and their pagers told them to write off those achievements.
	The Transport Secretary has bankrupted a private sector company by refusing to supply the money that most people reasonably thought would be supplied. He will now discover that it will cost him twice or three times more to try to pump life into a bankrupt Railtrack than it would if he had done a sensible deal at the time of the original negotiations. Railtrack remains a private sector company as it is under the control of private sector accountants who are earning hearty fees.
	The stated policy is that Railtrack will be returned to the private sector. There is some argument about the exact nature of the private company that will emerge and interesting troubles will be faced in getting it into the shape that the Transport Secretary would like. However, Labour Members must understand that, on current form and policy, he is not renationalising the company in the way that he suggests.
	In the blue corner is the Secretary of State for Health. He takes the view that the Blairite project is on track. He does not think that he needs to make a leftward genuflection to Labour Back Benchers. He thinks that his future is best assured by being the very model of a modern Blairite general. In contrast, the Transport Secretary thinks that he needs an awful lot of support from Back Benchers and that, if he has enough support, he will terrify the Whips and the Prime Minister into promoting him because otherwise he will become a confounded nuisance. The difference in strategy is interesting.
	The Secretary of State for Health is no more likely to privatise the health service than the Transport Secretary is to renationalise the railways. Again, we have to look through the Health Secretary's excellent spin. He is not about to say that people will have to pay a fee to go to the doctor or to have an operation and he is not about to sell off all our hospitals as profit-making operations and turn them into companies in the private sector. Nor did Conservative Ministers ever plan or wish to do that. We did not put that to the electorate or do anything similar during those long years in power.
	I make a confident prediction that my colleagues and I will not fight the next general election on a ticket of profit-making hospitals that are privatised out of the NHS; nor will we fight it on the ticket of making people pay to go to the doctor. Given that there is meant to be a better spirit in the Chamber during debates, it is disgraceful that such stupid ideas are still being retold by Labour Members who say, "Ah ha! Vote Conservative and you will have to pay £10, £20 or £50 to see the doctor." There is not a shred of truth in that, and I hope that Ministers stop saying it.

Martin Salter: The right hon. Gentleman, with his political career behind him, is known for his frankness. Will he interpret the contents of the memo issued by the hon. Member for Arundel and South Downs (Mr. Flight), the shadow Treasury spokesman, to the shadow Chancellor, which was copied to the shadow Cabinet? It states:
	"The reforms, which we will be proposing, will end the NHS monopoly and will entail those who can afford it making some payment for healthcare services."
	The right hon. Gentleman has rejected that concept. What does the memo mean?

John Redwood: I have not rejected that concept. Indeed, it is the policy of the Labour party, too. Hon. Members tend to be better off and we all contribute to our health care costs when we pay for prescriptions, eye treatment and dentistry. We pay for chiropody and for drugs that are purchased across the counter in a chemist's shop. The hon. Gentleman should understand that we have a mixed system in this country which has been supported by parties of both persuasions. He is trying to read something into the memo that is not there. It could cover his interpretation, but I am telling him that it does not. I am sure that my right hon. and hon. Friends have not been sitting around in smoke-filled rooms in the shadow Cabinet planning to charge people for visiting the doctor. They have made no such statement; there is no such policy; and we have received no such instruction on our pagers.
	I am going further than I should, but I am sure that members of the Conservative Front Bench want to rule nothing in or out because they are having a genuine and thorough policy review. They are listening to people and studying a wide variety of systems abroad. I am confident in predicting—I only predict when I am sure of my ground—that the Conservative party will not go into the next election with the proposal that people should be charged for going to the doctor.
	We think that there is one popular principle in the NHS which has been defended by all major parties in government since the founding fathers set it up after the war: if someone needs and wants health care of a stated range it should be free at the point of use. The first limitation on the wonderful promise that it would all be free came from members of the Labour party, the very founding fathers themselves, who decided to impose prescription charges. That policy has become bipartisan. Other changes, such as charges for checks on eyes and teeth, have also become bipartisan. The Labour party has had five years to change them, but it has seen the wisdom of keeping them as charges and of the generous exemptions.
	There is no great wish in the country to go far beyond those proposals. Indeed, there is a wish to honour the pledge that if we need and want care, it should be available in reasonable time to a reasonable standard with a reasonable amount of choice, to echo the thoughts of my right hon. Friend the Member for Hitchin and Harpenden (Mr. Lilley), the former Secretary of State for Social Security, who had good ideas on how choice could be introduced.
	The Secretary of State for Health would be well advised to be a little less pugilistic in such debates and a little more humble about the problems that many constituents face. I receive many letters from people whose GPs and, in due course, consultants at the local hospital have established that they need treatment. They have discovered that it will take a year or more to get the treatment that they need now, not after such a long wait. Quite a few of them, although not particularly rich, are busily privatising their health care because they are so frustrated and in so much pain. They want to get on with their lives. Some of them are of working age and want to get back to work, but the pain and the problem are impeding them from working properly or at all. So they simply cancel the holiday, sell the car, do whatever it takes, and pay a few thousand pounds for the operation in the private sector. That is happening on a large scale; for many people, that fundamental promise, in which I believe and in which I hoped the Government believed, is not being met.
	What do Members of Parliament usually discover when we write and complain or represent our constituents' views? I am not going to parade my constituents' problems in the House as they deserve a little confidentiality. However, some of them are suffering and in pain; they need my support, so I write confidentially to a Minister. I do not want to highlight their problems in the press because that is not terribly helpful. The reply always comes back, "Oh well, everything is now wonderful because we have spent £300 million on this, £400 million on that, a billion pounds on something else" and so on. Those numbers are meaningless to my constituents. As my right hon. Friend the Member for South-West Norfolk said, there is a growing gap between the way in which the public want the Government to respond to their problems and the way in which the Government are responding in practice.
	I invite Ministers to imagine going to their local department store to buy red socks. They would not be impressed if the department store said, "Sorry, we haven't got any. You could have some ties; perhaps in a year's time, we may have some red socks." They would probably not go to the store again or would kick up a fuss and tell it to get some socks. If they wrote a letter of complaint, would they be impressed if the shop's general manager wrote back, "I am sorry that there weren't any red socks, but you will be delighted to know that we spent £0.5 million on the sock department last year and will spend £1 million on it next year. Of course, for that £1 million we cannot guarantee that red socks will be available on the occasions when you may choose to come here, but please keep trying. Please keep taking the pills because one day we may have spent enough to have red socks when you come shopping"?
	People are paying an average of £1,000 each in taxes every year, or £4,000 for the average family, for the NHS. Of course, lots of transfers are going on; I am glad that the rich subsidise the poor and that the well subsidise the sick. Sometimes, transfers go the other way; the poor can subsidise the rich because it is possible to be rich and ill, although some Labour Members do not seem to recognise that, or poor and healthy. The main subsidies, however, go in the direction of which we all approve, from rich to poor and from the well to the sick. Ministers should accept that £4,000 for an average family of four is still a lot of money; people would like to get something more for it than they are currently getting.
	An interesting thread has run through the more thoughtful speeches in our debate. How is it that a new Labour Government can sweep to power, pick up where the Conservatives left off, and even, after two or three years, start hurling more money at the problem than the Conservatives, despite missing a couple of years when they first came to power, and yet nothing seem to improve? Indeed, as some of my right hon. Friends argued powerfully, in some ways and in some places, things are deteriorating; the money is not getting through and we are not getting what we want. In my own locality, we are waiting for a new hospital, which will not have nearly enough beds when it finally opens. Over the years, I have urged both Labour and Conservative Ministers to get on with the scheme and allow more beds in the redevelopment. I am always told by health experts that more beds are not needed because there will be more day surgery and hot-bedding. People will zip in and out; they will have a hip operation, then leap out of bed within three hours so that someone else can come in and do the same. Life is not like that; there will be considerable, growing demand for beds in which people can stay overnight or for a couple of days.

Martin Smyth: On a visit to New Zealand, the Select Committee on Health, met a medical manager who told us that when a hospital was allowed to have more than 400 beds, it ceased to be properly managed. I wonder whether in thinking about beds, we miss the real issue—that we are not getting suitable management to use what we have properly.

John Redwood: That is a valuable point; our system is over-administered and undermanaged. As described by my right hon. Friend the Member for South–West Norfolk, it has layers upon layers; an increasing number of trusts and committees preside over that massive expenditure and absorb a lot of money.
	What do we get? We do not get more operations; we get more glossy brochures. We do not get more nurses and doctors where we want them; we get more assistants, administrators, advisers and other consultants. We get more accountants and so-called financial control, but we do not seem to get the health care that we require.
	There was a certain poetic justice in hearing on the radio only this morning that the curse of the cuts has at last caught up with the Labour Government. I remember all those regular occasions when Conservative Ministers were invited into studios to be pilloried on that basis. Having announced hundreds of millions or billions of pounds of extra money, they were told that it represented a cut, because it was bespoke and people in the service for which it was destined always wanted more. Of course they did; that is the nature of the political and administrative bargaining process.
	As Labour spokesmen stoked up those issues in those days, it was apt to hear on the radio this morning no less a figure than the Secretary of State for Health clutching his billions and saying, "Haven't I done well?" but having to face a letter from a senior chief executive in the south-east health region. The letter was sent to all the chief executives of the hospitals in that part of the world. It said that they were in a dire financial situation and had immediately to make cuts of £60 million in the last two months of this year in order to live within what the Minister has described as very generous budgets. The letter went on helpfully to state that that would involve making very difficult decisions and damaging the clinical and medical services to the people in each of the areas concerned and in respect of each hospital and trust.
	The Secretary of State said that £60 million was rather a small sum, as that part of the country was getting £6 billion, and that anyone should be able to manage things better in order not to need the £60 million that the chief executive thought to be missing. The right hon. Gentleman is probably right, but the problem is that his chosen chief executive, who is responsible for finding the £60 million, could not do so. She said that it was impossible and that she could find it only by damaging medical and clinical services. The Secretary of State should be a little more humble. He should either decide that he has got the wrong person running that great big chunk of the health service—if it is so easy to find the £60 million, he must find the person who can get it without doing any damage—or accept that there is a problem and that these sums are not enough and he is at least £60 million light in that particular part of the world, and probably light in other parts of the world as well, as we will discover.
	When the national health service was launched in 1947, before most of us here were born, I imagine that its establishment was a great relief for many people who had voted Labour, or indeed had voted Conservative and were wedded to a similar type of scheme. It was a bipartisan view that people should be taken away from fear of the doctor's bill and that there should be much more state involvement. It was the question whether the hospitals should be nationalised that caused the dispute between the main parties. None the less, a bipartisan church had been working on the issue, as had Labour people. I can understand why. It must have been great. When the health service was set up, people on low incomes were offered a much higher standard of health care than they could previously have aspired to in terms of the voluntary arrangements and charging that predated the national health service.
	I often wonder what would have happened if, at the same time as launching the health service, or instead of doing so, Labour had said, "It is terrible that a lot of people are not rich enough to have a holiday, so we will set up a national holiday service." One can see how attractive such a proposal would be. Everybody would have a week's free holiday in a resort of their choice.

Peter Lilley: Not in the resort of their choice.

John Redwood: My right hon. Friend is ahead of me. First, they would have been offered the resort of their choice, just as they were offered the health care of their choice. However, if the then Government had introduced such a service and nationalised the buses and railways to get people to their destinations, we would now be sitting around debating why it cost so much to run the service and asking why I had been told that I must go to Skegness when I wanted my two weeks in Bournemouth. We would be asking why, although I said that I wanted to go on holiday in August, I was told that I had to go in February in two years' time, because there was a long waiting list. If somebody had then told me, "By the way, when you get there, you'll have to share a hostel dormitory with lots of other men, although I hasten to add that you'll be given your own bed," I would by that stage have decided that I had grown out of the national holiday service and that the lack of choice and the frustrations were not very good.
	Labour Members have been kind enough to giggle a little about that prospect, but I ask them to think about why we have not modernised the offering of the national health service as we should have done. Is it right that people should now be told that they have to go into mixed or even single-sex dormitory wards? Why is there not a choice of separate rooms or better partitions? Is it right that patients are offered a fairly standard table d'hôte menu? Could there not be more imagination in the range of meals and eating times?
	Is it right that there are so few additional services available even for those patients who would like to pay a little to enjoy different services while they are in hospital? Why cannot patients rent digital multi-choice televisions and computer systems to play with while they are trying to recover from an operation? Why cannot they have a range of services available at their bedside or, even better, in their room, to cheer them up? We are not thinking creatively enough about what people would like or about how we could use the money that people would freely choose to spend while still enjoying the benefit of the fundamental pledge to give them a roof over their head, the operation that they need and the nursing care that they receive in hospital.
	I know that the Health Secretary has said that he will consider such matters, and I hope that he does. I hope that he will also consider how private finance can be jazzed up and made to work a little better. There are too many cases of private finance delaying necessary developments and of a failure properly to transfer risk, which is part of the purpose of having a private finance initiative. Why does the Secretary of State not decide that it would be a good idea to alleviate the bed crisis by allowing private enterprise to build blocks of rooms on or adjacent to the sites of leading hospitals where that is physically possible, as it must be in many cases? People could then choose to rent the room of their choice while receiving free NHS care. Would that not build a proper bridge between the NHS and the private sector and help to create capacity, which is clearly lacking at the moment?
	We could then concentrate more NHS money on clinical and medical care, hiring more nurses and doctors, because we would not need as many ancillary staff if part of the hotel functions were paid for by patients choosing to spend their own money. Pay beds used to be anathema to Labour, but there are still some left. They would now be seen as a public-private partnership. I am happy to use that language because that is the sort of PPP that we need generously to expand so that we can give people more choice, modernise the service, bring in more money and provide more care and treatment.
	I still have too many constituents who cannot get the treatment that they need for the simple reason that there are not enough beds in the local hospital and there are not enough nurses and doctors to service the number of beds that we need. Those problems can be solved. The Government always say that there are not enough nurses and doctors because they inherited a situation in which there were not enough nurses and doctors. It takes three years to train a nurse. If the Government were very worried about the number of trained nurses in the country, all they had to do in their first or second year was to increase training, and by now they would have had as many nurses as they wanted.
	As my right hon. Friend the Member for Hitchin and Harpenden has said, there are many trained nurses throughout the country who choose not to work as nurses, either in the NHS or at all. The Government ought to address that because it shows that there is something wrong with the terms and conditions of employment in our hospitals. If the Government have so much money and the problem is one of pay, the solution is simple—to put up pay to a level that people find acceptable.
	I hope that the Government will listen to their colleague the hon. Member for Reading, West, if not to me, on the issue of pay differentiation. The hon. Gentleman is right to say that it would be fair to give nurses throughout the country a fairly equal standard of living rather than to pay them all the same amount. If they are paid the same, nurses in Reading and London will have a pretty miserable quality of life, while those in cheaper parts of the country will do a bit better, and that would not be terribly fair. The Government ought to consider how they can find a better solution to the pay problem, particularly in depressed parts of the country.
	If the problem is morale, as I fear in some cases it is, and working conditions, the great bevy of managers that the Government have brought into the NHS ought to be able to tackle it. If they cannot, the Government must sort out the management. I fear that the management is too cumbersome and complex; there are too many people in the chain of command, and health service managers often take a very defensive approach. It is much easier to have another consultation, hold another committee meeting or send out another glossy brochure than to make somebody responsible for something and try to make something happen as a result.

Geoffrey Clifton-Brown: Does my right hon. Friend agree that we cannot run the public service if we do not have the right people in it and that it is no surprise that we cannot recruit enough nurses, policemen and members of the armed forces if we cannot offer them the right working conditions? We should get back to giving them the right conditions, and to the situation that used to pertain when those who worked for the public services were regarded as key members of society.

John Redwood: I entirely agree.
	I must move on to transport, and I am glad to see the Transport Secretary in his place. He has set out the plans for what he thinks is a massive investment in new transport facilities. We have had the much advertised and much delayed £180 billion blockbuster 10-year plan. What strikes me about it is the poverty of expectation on private capital over such a long period and in such a large and prosperous country.
	What are the figures? The Secretary of State believes that we can raise only £56 billion from the private sector to supplement the substantial sums of public money going into the £180 billion. There are difficulties with the right hon. Gentleman's arithmetic, and when the figures are unpacked we discover that a lot of the £64 billion for railways—or is it now £67 billion?—is subsidy for existing activities. Not a great deal is investment in major new projects.

Don Foster: Following the 10-year plan, we had the Strategic Rail Authority plan. Is the right hon. Gentleman aware that it involves a 14 per cent. reduction in the private sector money that the Government expect to bring in? What does that say about Government confidence in that private sector investment?

John Redwood: The hon. Gentleman is ahead of me and he is absolutely right. The Government and the SRA have had to reduce expectations for the good reason that their plans are much delayed and much damaged by the actions taken recently. The original plan is some 18 months out of date, but the Government appear to have rolled it forward. It is still called a 10-year plan rather than an eight and a half year plan because they are worried about the gap in investment and new finance this year, which results from the problems generated by Railtrack's bankruptcy and the delay in agreeing the new franchises with the train companies.
	The investment in the railway is too small, so how could it be increased? The Secretary of State could and should immediately do two simple things to speed up and magnify that prospective private sector investment. First, he should return Railtrack to the private sector as quickly as possible. I hope that Ministers segregate that task. If the Secretary of State wants to, he should be the proponent of a company limited by guarantee—that will need a lot of detailed and hands-on work from the Government and the people who put it together—but a completely independent Minister, if one can be found, should judge the competition between the bidders, who would then need a licence from the Government.
	Whether the Secretary of State's CLG gets going or not—that will be expensive and difficult—I hope that he returns Railtrack to the private sector as quickly as possible. Why does he not tell us today that he intends to put out a sale memorandum within a month and that bids will close two months thereafter? That would show a sense of urgency. If Railtrack could be up and running as a private sector company by autumn—the first feasible date that the right hon. Gentleman could possibly achieve—we would lose only about a year of the investment programme and we might be able to rebuild more quickly.
	On the timetable that the Government seem to be following, however, a much longer period in administration is in prospect. I am sure that there are all sorts of problems in compiling an accurate and detailed sale memorandum, but they are exactly what the Secretary of State must cut through if he is serious about private sector investment in the track.
	An even easier task for the Secretary of State or his SRA is getting investment in rolling stock going again, although it has been badly damaged by a company's discovery that there is not enough power in the network to run the new trains that it has bought. That will deter other companies from buying other types of new train that might be power hungry. More importantly, delay and damage have been caused by the failure of the SRA and the Secretary of State to renew franchises. Worse, they have told the industry that they do not like the current structure and that they want the train operating companies to be merged.
	We have not heard the exact way in which the Secretary of State and the SRA want that to happen or how they can insist on private sector companies doing it. We live in expectation of learning that. They have devised the particularly silly policy that only one train company can use a specific London terminus. Why does not the Secretary of State apply that to aviation? Why can all sorts of different airlines use a single airport, where management problems are greater because not allowing a plane to land is a serious matter? By contrast, holding a train outside a station is a relatively easy task, which does not entail worrying about safety.
	It is odd that the Secretary of State has such a tidy mind that he wants only one train company in any London terminus. What happens cross country is more difficult to judge; I presume that he would allow more than one train company to use Crewe or Reading, where different companies go although they may travel to a different London terminus.
	The policy that I have described would delay ordering new trains because sorting out the mergers and the amalgamations of franchises will take time. It would delay negotiations of the new franchises, and companies will not order new rolling stock during that time. They want to know whether they are winners or losers—whether they will survive or go down. They want to know the sort of franchise that they will get before they commit a decent amount of money to new investment.
	The Secretary of State could make two decisions today to begin to solve the problems. If he does not do that, we will not get a fair proportion of the money for the 10-year plan in the next two or three years, and there will be nothing to show for it before the general election.
	Why will the remainder of transport receive only £120 billion? That is not much money. Let us put it in the context of British people buying 10 per cent. fewer cars each year than they bought last year, which was a good year for buying cars. That applies only if one likes buying cars. It was a bad year for the Government, who do not like people having cars.

Angela Watkinson: What is my right hon. Friend's view of the plans of the Mayor of London to introduce congestion charging and the likely burden that that will place on public sector workers such as firefighters and ambulance drivers who work inside the charging area but cannot afford to live there because of property prices? They have to drive their cars to work because they work unsocial hours or have to carry equipment with them. I understand that the Secretary of State has the power to exempt groups of people from the charge. Does my right hon. Friend agree that he should use it?

John Redwood: Yes, I agree with my hon. Friend that if the Government were foolish enough to press ahead with such a scheme, they would have to make generous exemptions. I am sure that many Members of Parliament would expect to be exempted, too, because they regard themselves as important workers who do not live in London but clearly work there from time to time. The embarrassment caused by exempting Members of Parliament would be interesting. However, we are trespassing on private grief: the Mayor is keener on such a scheme than the Government. We shall watch this space.
	I mentioned the scale of investment. If we assume that 10 per cent. fewer people than last year buy cars in the next 10 years and that, on average, they buy a modest new car, that would mean total investment of £180 billion over 10 years by private individuals and companies in private motor cars. That puts into perspective the figure that the Secretary of State claims is large. If we add the money that companies spend on lorries, vans and so on, the amount would be much more than £180 billion. Of course, the Secretary of State omits private investment in motor vehicles from the plan, but he includes private investment in trains. That is an interesting method of calculating transport investment.
	The British people know their Government well. We had a record year for new cars last year, and that clearly suggests that people have decided that public transport will not work well or quickly under the Government. They will therefore continue to try to upgrade their cars and increase the number of cars per family because they have to use that mode of transport to get around.
	It is not that many people are fanatics about their cars in the way that some Ministers suggest. Many people have no choice. In a rural area, there is absolutely no choice; in an urban area, there is no choice for certain journeys. It is becoming so difficult to get to stations in big towns and cities these days that people often decide that, instead of battling for three quarters of an hour or an hour to get to the station, they might as well spend 20 minutes getting on to the motorway network and getting somewhere. They conclude that they probably do not use much more petrol doing that, and that they will save a lot of money and inconvenience. Ministers will have to work hard to get the private capital into the system, and they will have to work with local government to understand why so many people are voting with their cars and with their feet, and are unwilling to take the public transport option.
	The other day, I was invited to a presentation at the Department for Transport, Local Government and the Regions in my capacity as a Member of Parliament representing a Thames valley constituency. The presentation was designed to bring us up to date with the so-called multi-modal study affecting the M3-M4 area, from just outside the M25 to Reading. We had a long, academic debate about whether this was the right region to consider—apparently, many opinions have been expressed and many papers written on that—and we were told that one of the aims of the thing was to see how the Department could come up with a solution that would solve more of our transport problems with trains, and by switching people out of their cars.
	I do not know whether the Secretary of State is aware that his Department is, at the same time, saying that Wokingham alone will have to absorb 7,750 new houses over a 15-year period. Families will move into those homes as they are built, and they will be two or three-car families, because that is the nature of the area. Far from limiting traffic or vehicle use, therefore, the Secretary of State's own Department is busily undermining his integrated transport policy with a planning decision that is deeply unpopular in my constituency and which will greatly increase the traffic problem.
	The Secretary of State should also be aware that we are currently short of capacity on the trains as well as on the roads. It is not an answer to say that all we have to do is switch people out of their cars on to the trains that are waiting there for them. The trains are not there. The Secretary of State says in his plan that he reckons he can increase train usage by 50 per cent. over a 10-year period. As a starting point for that increase, we currently do only about 6 or 7 per cent. of our journeys on the train, so even if we increase train travel by 50 per cent., the trains will still only take up about a year's worth of total traffic growth. There will not be a switch, in terms of proportion, from cars to trains, on that very modest figure of 50 per cent. growth in train use. Unfortunately, achieving even that growth is going to be problematic, given the lack of decisions that we have seen so far.
	I urge the Secretary of State for Transport to understand that, in an area such as mine, people are buying cars and using them. They are very frustrated; they cannot get to the stations easily, and when they do, there is insufficient capacity on the trains. South West Trains does not have a renewed franchise, and it is not making any investment until it gets one. The local council and South West Trains cannot put in the new station until the Railtrack problem is sorted out and South West Trains have a franchise. The reality on the ground is that the billions being talked about by the Government are not achieving any improvements whatever, and things are often getting worse.
	I am sure that the Secretary of State will be able to come to the House in a couple of years—if he is still Secretary of State—and say that much more money has been spent on the railways over those two years. But most of that money will be tipped down the drain. It will go on the fees of the administrator and the consultants, the losses being built up by a business whose morale has been shattered, and the losses that will be incurred because the business is no longer controlling its costs in the way that a private sector company would have done. Public capital will be going in, where private capital could have gone in if the company had not been bankrupted.
	We have seen great problems in the public services, and they are getting worse. More money is sometimes helpful, but in all too many cases, more Government money is going into the wrong things and making the problem worse rather than better. We need a massive expansion of private capital in health and in the railways. The two spinners—the two Secretaries of State who sit there like Tweedledum and Tweedledee—suggest to their Back Benchers that they are going in different directions, but they are fundamentally united in their purpose. They believe that the art of government is in spinning, and they will both preside over a substantial deterioration in the services in their care.

John Smith: I am grateful for the opportunity to make a small contribution to this debate. Indeed, I am grateful to the Opposition for tabling the motion, because it gives me a chance to focus on a public service that has been a huge success story in my constituency: the police service. Incidentally, Opposition Members have hardly mentioned that important public service during this long debate. I believe that that is because of its success in the past four and a half years.
	Given that I have had the dubious honour of listening to most of the speeches made by Opposition Members on their chosen topic, I shall make a couple of observations about them before going on to the constituency issue that I wish to raise.
	I cannot ignore the unsolicited references by the right hon. and learned Member for Rushcliffe (Mr. Clarke) to my constituency and the Vale of Glamorgan by-election, not once or twice but, as Hansard will confirm, six times. That convinces me that it must be haunting him—and so it should. I remind the House that that by-election in 1989 was based on the state of one of our most important public services, the health service, all that time ago when the right hon. and learned Gentleman was pushing through the Tory health reforms.
	I am eternally grateful to the right hon. and learned Gentleman for my getting elected in that by-election. Had it not been for his personal intervention, I would not have been elected. I thank him for the fact that I have won every election—I have had the majority vote from my electors in every election—since 1989, which is in part due to his intervention. [Interruption.] The hon. Member for West Chelmsford (Mr. Burns) shouts from a sedentary position that I lost in 1992. Let me tell him that my electors elected me in that election. It was 64 South Africans who made the difference in the fiddled election system that the Tories introduced in the meantime. [Interruption.] Ask them to check the record, Mr. Deputy Speaker.
	It is a pity that the right hon. and learned Member for Rushcliffe is no longer in his place. In his speech, he said that the Tories lost the 1989 by-election because there was a conspiracy between the Labour party and the British Medical Association to fight the election under the false claim that the Tories intended to privatise the health service and to introduce charges. He may believe in conspiracy theories, but I do not and he is wrong to think that there was one then.
	The doctors acted entirely independently. They put forward a GP candidate and fought the election on the argument that the Tories intended to privatise the health service. I do not believe that that was the right hon. and learned Gentleman's intention. Nor do I believe that there was at that time a specific proposal to introduce charging, but it unravels the argument put forward in the Conservative motion today. The truth is that the Tories do not support the national health service or public services. The motion makes no reference whatever to support for, or commitment to, the public services, or to enhancing or strengthening them.

Chris Grayling: I wonder whether I could pose a question to the hon. Gentleman. If it is the case that the Conservative party has no interest in the public services and in the national health service, and that the Labour party has that interest, how can it be that the chairman of the Labour party recently admitted that the state of the health service in many ways is worse than it was under the Conservatives?

John Smith: That has nothing to do with the mood music of the parties today. There has been a week or two of bad publicity regarding public services, so the Tories have jumped on the bandwagon and tabled a motion for an Opposition-day debate on public services. That is very brave of them, but no one in the country believes that they have any commitment whatever to the public services. If they do not believe me, they should look at the opinion polls in today's newspapers, which show that despite the difficulties in recent weeks, despite Captain Mainwaring, the Leader of Her Majesty's Opposition, jumping on the bandwagon and all of a sudden coming out in favour of public services, no one in the country believes them.

Andrew Selous: The Leader of the Opposition was a public servant a long time ago and a member of Her Majesty's armed forces, so he is hardly jumping on a bandwagon.

John Smith: Absolutely. That is why it is amazing that that other great public service has literally not been mentioned until now by the Conservative party. The reason is—the hon. Gentleman may not be aware of it—that the Conservative party does not support public services or the public ethos. It believes that public service is a necessary evil that has to be provided because the private sector either cannot or is unwilling to provide it. The public services will never be safe in Tory hands.
	The Tories have got on the public service bandwagon this week. The other week, we had another beauty: they came out in favour of reforming the second Chamber to have 80 per cent. elected peers, whereas 12 months or a little longer ago they did not even support the abolition of hereditary peers. The good captain in charge has panicked. He has literally been non-existent on the political scene for the past six months and he is picking up each bandwagon as it comes along.
	As today's opinion polls show, the Tories will not win the argument and they will not win support, despite the order from the good captain, "Don't mention the euro." John Cleese in "Fawlty Towers" said not to mention something else, but that is the line in the Tory party: do not mention the euro, pretend we support public services and say anything we possibly can to get on the next bandwagon.

Chris Grayling: Does the hon. Gentleman not recognise that week by week we as individual Members of Parliament receive either letters or visits in our surgeries from people who are suffering as a result of the failures of his party to deliver improvements in public services? How can he say that it is us who have no interest in this area, when it is palpably his party that is presiding over a situation that is getting worse, not better?

John Smith: Because the Conservative party had 18 years in charge of the public services and they ran them down to an appalling level during that period. There was no transport plan for nearly 20 years. Hospitals were closed. There was a reduction in the number of beds, nurses and doctors. That happened not because the Tories wanted to take health care away from the British people, but because of their ideological belief that the private sector is always best. They believed that if a gap were created in health care services it would automatically be filled by their friends in the private sector. Of course, that did not happen.

Andrew Selous: Like several of his colleagues, the hon. Gentleman seems to be keen to give us a history lesson, but will he remember that it was his party which was unable to fulfil its hospital building programme and to fund nurses' pay when they were in power in a previous Administration? If we are going to look at history, perhaps we should look at it fairly on both counts.

John Smith: I am happy to make historical comparisons, particularly this one. In the last few years, the country has seen the biggest hospital building programme that it has seen for decades, and a greater increase in nursing recruitment than it has seen for a long time. According to an answer given in Health questions this afternoon, 10,000 were recruited last year. Yes, I am happy to make comparisons showing the record of a Labour Government who are committed to the public service ethos—who believe in public services, considering them to provide not just the best but the fairest way of ensuring that the many benefit, not just a few who can pay.
	That is not just my view, but the view of the British people. It will not be changed by a couple of policy pronouncements that have been made in the last couple of weeks, or by a motion that does not even state that the Opposition support public services.
	Much has been said today about some of the Government's difficulties in providing services. It should be recognised that the climate in which they are being provided now is very different from the climate under the Tories. We now have a successful and growing economy. We have the lowest unemployment for more than 25 years, taking into account regional variations, and we have growth rates that have not been enjoyed for a long time. We have the lowest inflation for nearly 40 years. That successful economy is the backdrop to the current situation.
	One consequence is that the problems we now face in delivering public services are very different from those experienced during the 18 disastrous years of Tory provision. Of course it can be difficult to recruit nurses and teachers, because competition in the labour market is 10 times greater than it was during that disastrous Tory period. That means that we must be more innovative, and introduce new policies to overcome the problems.
	I want to draw Ministers' attention to the arbitrary tests imposed on new nursing recruits. I have reason to believe that they do not necessarily reflect the ability and aptitude of potential recruits. I understand that many young women, in particular, want to move to the profession from managerial and other backgrounds, but cannot surmount that initial hurdle. The same applies to teachers. We are offering incentives for teacher training, but it seems that potential recruits are being put off. I think we should examine the standard of access to teaching and postgraduate certificate of education courses.
	The main issue that I want to raise is the success of the police service in my constituency. We can, I think, be very proud of the Government's record in regard to the tackling of crime. In the past four years, we have reduced crime by 22 per cent. In my constituency, there has been a 33 per cent. reduction in recorded crime in the past five years alone. There were 15,000 recorded incidents in 1996, but the latest crime survey figures show that the number fell to 10,000 last year. That is a fantastic achievement by the police and their partners in my constituency.
	That would be a wonderful achievement in its own right, but 10 years ago the crime rate in my constituency, and in the town of Barry there, was the highest per capita among all comparable communities in the UK.

Angela Watkinson: The hon. Gentleman is extremely lucky to have either a good police service in his area, or adequate resourcing. My neighbouring constituency has the largest concentration of night clubs in the Metropolitan police district, apart from the west end of London. The demands that have to be met in the late-night entertainment centre in that constituency mean that there is often no police officer on duty on Friday and Saturday nights in my constituency.

John Smith: I sympathise with the hon. Lady, as my constituency's principal town, Barry, is a major seaside resort. We have many clubs and entertainment centres that attract lots of people, especially through the summer. They create difficult policing problems, but even so crime has been reduced in the way that I described.
	There is no doubt that the fall in the crime rate is due in part to the extra resources that have been given to police in our area, which mean that there are more police on the beat. It is also in part a result of close work with communities in the area. There is a very close partnership between local authorities, voluntary groups, the police and the schools. Large-scale preventive measures have been taken to help reduce the crime rate, and they have been incredibly successful.
	A number of other reasons for the fall can be adduced, and one is that we have damn good coppers. Another factor is the good leadership in the area's police force. For the first time in a long time, many serving policing officers in the Vale of Glamorgan division who work in and police the area also live there, and bring their children up there. Their children go to local schools, so the officers have a shared and vested interest in seeing crime tackled in the area. We have moved away from that strategy over the years, and we should return to it.
	The achievement in my area has been so remarkable that it was recognised at the end of last year by my right hon. Friends the Prime Minister and the Home Secretary. South Wales Police achieved one of the highest reductions in crime in the UK, and the chief constable, the local superintendent of police, whose name is Colin Jones, and some serving officers were invited to No. 10 Downing street. They were congratulated on the excellent public service that they had been providing over four or five years and on the excellent statistics that they had achieved. They were invited to discuss with my right hon. Friends some of the reasons for their tremendous record.
	I emphasise that the record is tremendous. I recall bringing business and community leaders to the House to make representations to Home Office Ministers about the level of crime that existed some 10 years ago. The crime rate was so bad then that I would not mention it in debates in this House. I did not want the area that I represent to suffer from any associated bad publicity, but we wanted something to be done. The problem facing local businesses, clubs and entertainment establishments was not that they were struggling in a difficult economic climate, but that the crime rate was so bad that they could not get insurance companies to insure their buildings or stock, and they could not trade as normal. That is how bad the situation was, but 12 years later we have the safest community in south Wales and one of the safest in the United Kingdom, with one of the largest reductions in crime figures in the UK.
	I want my right hon. and hon. Friends on the Front Bench to know that we are extremely grateful that the chief constable of South Wales Police was recognised with a knighthood in the new year honours. I have no doubt that had something to do with his excellent achievements. I hope that the achievements of other officers—in particular Superintendent Jones and his team in the Vale of Glamorgan division—will be recognised in the same way. They have all played an important role.
	The Government's success in public services in my constituency is not just the result of increased resources, preventive policies and working in partnership. A major contribution has been made by the radical reduction in poverty and unemployment. There is a direct relationship with the reduction in crime. Do not ask me—ask any local bobby. When the police used to apprehend someone who was up to no good, the first two questions they asked were, "Are you working?" and "Where do you live?". The officers could usually narrow down their suspects by knowing their income or the area or conditions in which they lived. That has disappeared because of the dramatic improvement in the elimination of poverty and the reduction in unemployment. In my constituency, unemployment has fallen 40 per cent. in the past four and a half years. Youth unemployment, which produced the biggest perpetrators of crime, has fallen by 70 per cent. Neither unemployment nor poverty excuses crime but they do explain it.
	Today's Opposition debate was rumbled when the right hon. Member for Hitchin and Harpenden (Mr. Lilley), the former Secretary of State for Social Security, said that there is no relationship between poverty and health. That is the one statement people will remember from today's debate. The Opposition do not believe that there is any relationship between the health of the people of this country and their ability to get a job, live in a decent house, enjoy a decent diet, wear decent clothing and look after their children properly. Conservative Members do not make that connection because they do not in their hearts believe in the ethos of public services—and never will. Today's debate has been an absolute sham and the people of this country will rumble them.

Theresa May: I refer hon. Members to the declaration that I made on 14 January 2002 at column 33.
	This has been an interesting debate and there have been several excellent contributions from Conservative former Secretaries of State, but in many ways it has been a tale of two debates, because many Labour Back Benchers have simply taken us on a ramble through history. They seem to think that the world stopped in May 1997 and that nearly five years of Labour Government is a thing of fiction. Sadly for patients, pupils and passengers, the Labour Government are too much of a reality—a reality that is delivering deteriorating public services and a demoralised work force.
	My right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) put his finger on the truth when he said that Labour Members should understand that outside the House there was widespread anger and shame about the state of our public services, and that people's disillusion came from a despair that the current politicians would ever resolve the problems that had been created in our public services.
	People would be even more angry and disillusioned if they had heard most of Labour Members' speeches tonight, because their cavalier attitude to the chaos in health, transport and education—their disregard for the devastation that their policies have wrought in public services—was breathtaking in its arrogance.
	Perhaps my right hon. and learned Friend the Member for Rushcliffe gave another clue when he said that he had hoped to find a consensus today on the need for diversity and choice and the involvement of the private sector, particularly in the health service, but saw instead the dead wood on the Labour Back Benches failing to recognise not only the needs of patients, parents and passengers, but even the policies of their own Ministers.
	I said that we had a number of rambles through history. The hon. Member for Coventry, South (Mr. Cunningham) indulged in a very slow ramble through history, completely ignoring the record of his own Government in its first term from 1997 and completely ignoring the reality of the services that people have to use day in, day out.
	The hon. Member for Worcester (Mr. Foster) painted a picture of Government success in Worcester. He even spoke about success in education. That is not the sort of success that I remember from the delegation of heads from Worcestershire who came to see me when I was an education spokesman, to complain about levels of funding for their schools.
	I am sorry that I missed the speech by the hon. Member for Reading, West (Mr. Salter).

Simon Burns: My hon. Friend missed nothing.

Theresa May: My hon. Friend says that I missed nothing. I am sorry that I missed the speech, because the hon. Gentleman has previously been quite critical of his own Government's record in the past four and a half years. [Hon. Members: "Where is he?"] Indeed, sadly he is not here to listen to these winding-up speeches.
	When the hon. Member for Vale of Glamorgan (Mr. Smith) took an intervention from my hon. Friend the Member for Epsom and Ewell (Chris Grayling) about the comments by the chairman of the Labour party about how bad the health service was under Labour, the hon. Gentleman said that that did not count because it was not part of the mood music. I suggest that the hon. Gentleman stands on doorsteps and tells patients who have been waiting on trolleys for hours that it does not matter because it is not part of his party's mood music and sees what sort of answer he gets from them.
	The honourable and notable exception to all those speeches by Labour Members came from the hon. Member for Dartford (Dr. Stoate), who is present. I was a little concerned when he started his speech by saying that it is not just size that matters, but how you use it.

Howard Stoate: I can prove it.

Theresa May: It is a good job that my husband is not present to hear the hon. Gentleman suggest that he could prove it to me, but the hon. Gentleman's speech revealed a refreshing approach from a Back-Bench Labour Member. He said that the monolithic structure of the health service was a problem and that money was not the only answer. He cited several examples of the way in which innovative thinking should be introduced into the health service to solve the problems. I suggest to the Secretary of State for Health that he watches out for his job, because it sounds to me as though the hon. Member for Dartford has rather more ideas about the future of the health service than the Secretary of State has.
	We made an amazing discovery in the speech—I have to say that it was a shambles of a speech—made by the hon. Member for Oxford, West and Abingdon (Dr. Harris). We know that the Liberal Democrats say one thing nationally and another thing locally and that Front-Bench Liberal Democrat Members disagree among themselves and have different policies, but what we heard tonight was a Front-Bench spokesman for the Liberal Democrats disagreeing with himself within five minutes in his own speech. He denied, but then confirmed, that the Liberal Democrats are considering charging for access to the NHS.

David Miliband: I am sorry to interrupt the hon. Lady; I am genuinely grateful to her for mentioning charging. When we last debated public services in the House, the shadow Chancellor refused to repeat his party's manifesto commitment to an NHS free at the point of use. Does she support the shadow Chancellor or her manifesto, on which she stood for election at the last general election?

Theresa May: I would have more reason to answer the hon. Gentleman if his party knew what its own policy on the health service was—it does not know, as I shall go on to say later in my speech.
	We heard particularly powerful contributions from my right hon. Friends the Members for South-West Norfolk (Mrs. Shephard), for Hitchin and Harpenden (Mr. Lilley) and for Wokingham (Mr. Redwood). My right hon. Friend the Member for South-West Norfolk made the very valid point that it is time that the Government took responsibility for being in government and for their record in government. Her criticism was particularly trenchant when she talked about the Government's complete failure to understand the needs of rural areas.
	My right hon. Friend the Member for Hitchin and Harpenden made a number of very important points about the difference between official figures on teacher vacancies and the reality faced—day in, day out—by schools throughout the country. He pointed out what seems absolutely clear to everyone but the Transport Secretary: the Strategic Rail Authority 10-year plan for the railways fails to deliver what is needed—an increase in capacity. As my right hon. Friend the Member for Wokingham said, money is being thrown down the drain to advisers and consultants because Railtrack is in administration, while the Government completely fail to set out their criteria for bidders to take over Railtrack and to take it out of administration.
	Let us come to the state of our public services. An insight was given into that recently by the Deputy Prime Minister in his speech to the Fabian Society. He spoke about part of his own constituency and said that it was not unique. He then said:
	"Across the land are neighbourhoods just like it—where public services have let people down, badly."
	With observations like that, perhaps it is little wonder that the Deputy Prime Minister is now being rubbished by the likes of the Minister for Europe.

Phil Hope: Will the hon. Lady give way?

Theresa May: No, I will not give way.
	The Secretary of State for Health in replying to this debate attempted to paint a different picture—one of delivery in the health service. Of course, that picture is totally at odds with the experience of patients who wait hours on trolleys and who return from holiday to find that their operations have been cancelled while they have been away and that they have been taken off the waiting lists.
	The 2,000 more people waiting for operations for more than 12 months than were waiting in May 1997 and the 400,000 people waiting just to get on the waiting lists know the painful reality of the Government's failure to deliver on the NHS. I will give the Secretary of State for Health his due; he did say one interesting thing during his speech—that we have a very good Transport Secretary. That is the first time in the House that I have heard a Minister refer with such warm words to Lord Birt.
	My hon. Friend the Member for Woodspring (Dr. Fox), in a powerful opening speech, reminded us clearly of the extent of new Labour's failures in health, education, transport and law and order. The list goes on. As he said, the problems faced lie in the very ethos of new Labour, because the Government's propensity to centralise, micromanage and interfere—overlaid with the obsession with spin that is so characteristic of new Labour—has led to problems in the public services.
	Perhaps that is best revealed by the Government's obsessions with plans. In the health service, we have had the NHS plan, the Wanless plan, which was going to be the answer, and the Secretary of State's new plan that was brought out last week.
	However, perhaps transport is an even better example. The Government issued a 10-year transport plan. One year on, it is being reviewed. That is hardly surprising given that a hole has been blown in it by the fact that Railtrack is in administration. Last week, the Strategic Rail Authority issued another 10-year plan and the Secretary of State for Transport, Local Government and the Regions told us:
	"No more vague aspirations or grand visions strong on rhetoric but weak on delivery. This plan is an agenda for action."
	A 10-year plan for delivery, or is it? The Secretary of State gave an interview to the BBC's "On the Record" programme on Sunday and the following exchange took place:
	"Mr. Humphrys: 'And that ten-year plan is now fixed. That is, that's there, that's solid, that's in concrete?'
	The Secretary of State: 'The obligations are there. I've said though I want it reviewed every year, because there's no point in having a ten-year . . . '
	Mr. Humphrys: 'So it's not really a ten-year plan then?'
	The Secretary of State: 'Well, it's a ten-year plan as we sit here today, but it's got to be flexible John, because if you set it . . . '
	Mr. Humphrys: 'So there might be a different ten-year plan this time next year?'
	The Secretary of State: 'It'll be the same ten-year plan, but we'll review it in the light of . . . '
	Mr. Humphrys: 'So it might be different, but the same?'
	The Secretary of State: 'Well. we'll explain.'"
	Let me explain to the Transport Secretary that people are fed up with plans that fail to deliver improvements on the railways.
	Who will be responsible for reviewing the plan? The Department for Transport, Local Government and the Regions, the No. 10 policy unit on transport, the No. 10 forward strategy unit on transport or the strategic transport unit in the Treasury?
	One of the causes of the uncertainty in the railways is the fact that Railtrack is in administration. That has been made absolutely clear by the Strategic Rail Authority in its 10-year plan. No one knows how long Railtrack will stay in administration or what will replace it.
	Again the Secretary of State made some interesting revelations in his "On the Record" interview. He told John Humphrys:
	"'Well, you're assuming that the model that replaces Railtrack is going to be the same as Railtrack.'
	Mr. Humphrys: 'We have to assume something because we don't know what it's going to be.'
	The Secretary of State: 'Well, you don't, but in due course, and basically, I mean people say, why is it taking so long? This administration, you know, three, six months, is it going to take longer?'"
	That was the Secretary of State's answer to the question of how long Railtrack would be in administration. While it is in administration, it is the Government's responsibility; it is neo-nationalisation. They were happy enough for it to be in the private sector when they took £155 million in windfall tax from it in 1997, but they will put it back in the private sector in the same railway structure as before.
	The Secretary of State has delivered a 45 per cent. increase in train delays, demoralised staff, Railtrack in limbo and a strategic plan that depends on £34 billion of private sector investment that has been jeopardised by his action on Railtrack. Perhaps he would do the House the honour of telling us what the overall private and public sector investment figure is due to be under his 10-year plan. Some say it will be £67 billion. In his response, will he confirm that the overall investment figure is, indeed, £67 billion?
	Of course, the railways are not the only problem: there is London Underground as well. The Prime Minister says that the public-private partnership will go ahead; the Secretary of State says it might not. We now read that it will all be okay because the Prime Minister has taken charge. Tony's roadshow is here: he is going to take his jacket off, roll his sleeves up and persuade people that a botched PPP for the underground is the answer when people know that it is not. As the Transport Commissioner for London said:
	"it will . . . be the best thing since Barnum and Bailey".
	The Government have presided over a shameful deterioration in public services. Patients are waiting longer, passengers are waiting longer, schools are waiting for teachers, and it is time that the Government stopped blaming others, accepted their responsibilities and started delivering on their promises.

Stephen Byers: The debate, initiated by the Conservative party, managed to feature only four speeches from the Tory Back Benches, each of which was delivered by former Cabinet Ministers parading their excuses for years of Tory failure in government. They cannot tolerate the fact that a Government are in office who are delivering on the public service agenda. We also heard, however, from constituency Labour MPs, who could see how we are delivering and the improvements that we are making.
	My hon. Friend the Member for Coventry, South (Mr. Cunningham) used his experience as leader of Coventry city council to demonstrate the difficulties that he had during a period of continuous cuts in public spending. My hon. Friend the Member for Worcester (Mr. Foster) explained that more police are being employed in his constituency. He said that investment is being made in CCTV and a new police station being constructed. He also pointed to the improvements in health provision in his constituency, with a new hospital that has been provided by the PFI, and the better results in education.
	My hon. Friend the Member for Reading, West (Mr. Salter), not always a complete supporter of Government policy, demonstrated from his impartial position the way in which services across the board—education, health, policing and transport—have improved significantly. My hon. Friend the Member for Dartford (Dr. Stoate) stressed the importance of real-terms increases in public spending. He also raised concerns about the need to ensure that pharmacists explore the better use of drugs, and reduce waste and the inappropriate use of drugs. My right hon. Friend the Secretary of State for Health will take up those specific issues.
	My hon. Friend the Member for Vale of Glamorgan (Mr. Smith) stressed the importance of policing. He referred to the difficulties in Barry in his constituency and mentioned the reduction in crime there. He also drew attention, as did the right hon. and learned Member for Rushcliffe (Mr. Clarke), to the lessons to be learned from the Vale of Glamorgan by-election in 1989. As my hon. Friend pointed out, although he technically lost his seat in the 1992 election, in reality he had a majority among people resident in the constituency. [Hon. Members: "What?"] The votes from those resident in South Africa won the day.
	Most telling were the contributions made by former Tory Cabinet Ministers. The right hon. Member for Wokingham (Mr. Redwood) clearly said that members of the Conservative Front Bench have not ruled anything out in terms of policy development. That is the real threat that hangs over public services in this country. When my hon. Friend the Member for South Shields (Mr. Miliband) asked the hon. Member for Maidenhead (Mrs. May) whether she would rule out charging for clinical services, she took a Trappist vow—no comment was made. She wants to be careful. Bearing in mind that this is the new, inclusive Tory party, as expounded by its leader, the hon. Member for Woodspring (Dr. Fox) talked about playing in the big boys' league. The hon. Lady clearly has difficulty playing in the big boys' league if she cannot answer such questions. So much for the inclusive Conservative party as proposed by its leader.
	I am pleased that the right hon. Member for South-West Norfolk (Mrs. Shephard) acknowledged that the Labour Government are investing more in public services—I welcome that refreshing honesty from the Opposition. The right hon. and learned Member for Rushcliffe said that the Labour Government were building on Tory success and our great economic legacy from 1997—[Hon. Members: "Hear, hear."] Well, let us look at the former Chancellor's record. Between 1993 and 1997, when he was in office, national debt increased by £100 billion. In the last year of his chancellorship, there was a real-terms decrease in NHS spending.

Kenneth Clarke: The right hon. Gentleman seeks to curry favour with his colleagues by trying to rehearse the Chancellor's arguments on economic policy before 1997. Will he turn to his transport policies for the present? How long will the Railtrack administration last, and what will be the consequences for investment in our railway network once he has managed to get an institution back in place to administer it?

Stephen Byers: I know that the Conservatives find it difficult—[Hon. Members: "Answer."] I shall answer, but in my own terms. I know that the right hon. and learned Gentleman and his hon. Friends find it difficult to acknowledge that we have killed off a failed Tory privatisation. We did so because we decided that we are not putting the interests of shareholders first, but the interests of the travelling public.
	The most telling speech from the Tory Back Benches was delivered by the right hon. Member for Hitchin and Harpenden (Mr. Lilley), who revealed the depths of Tory thinking when he said, "We do not accept that poverty is a cause of ill health"—a classic example of the Tories not allowing the facts to get in the way of prejudice. Let us have some facts. At the end of the 20th century, a boy born into a family on the lowest income will, on average, live nine years less than a boy born to a family with a professional background.

Peter Lilley: The Secretary of State should be a little cautious about being derogatory about ex-Cabinet Ministers, as he may shortly be joining that club. Will he answer my principal question about his responsibilities and confirm that up to £2 billion that is to be spent on the Thameslink 2000 project will not result in a single extra train service at peak times?

Stephen Byers: I shall come to Thameslink 2000—[Interruption.] Opposition Members do not like the facts to be given. The right hon. Gentleman made an important statement about ill health not being linked to poverty. I have already made the point that a boy born into a family on the lowest income will, on average, live nine years less than a boy born into a professional background. Life expectancy in Manchester is seven years less than in Kingston upon Thames in Surrey. Infant mortality is 17 per cent higher among the most disadvantaged groups in the country.
	The right hon. Member for Hitchin and Harpenden will know that, as a result of the failures of Railtrack, which wanted to stand down the team driving the project through, Thameslink 2000 has been delayed. With the new management of Railtrack, and with the Strategic Rail Authority operating, that contract and project will be put on track; we shall deliver the improvements that the right hon. Gentleman and his constituents want. [Hon. Members: "When?"] We shall do so when negotiations are completed. Like the west coast main line, those projects, which were supposed to be dominated and controlled by Railtrack, have fallen behind because of the management failures of Railtrack.
	Investment is crucial in high-quality public services, which provide the foundation of economic prosperity and social renewal; it generates wealth as well as supporting welfare provision. As a nation, we have suffered for generations from chronic underinvestment. It is because we in the Labour party believe passionately in public services that we will ensure that the extra money is made available. Ultimately, the hospital patient, the school pupil, the rail passenger and the potential victim of crime must come first.
	The British people will not be fooled by the Tories' new rhetoric on public services. People know from their own bitter experience that the factors that have motivated the Tory party over the years—envy, self-interest and greed—are simply incompatible—[Interruption.]

Mr. Speaker: Order. I ask the House to calm down. I cannot hear the Secretary of State.

Stephen Byers: Envy, self-interest and greed are incompatible with the provision of public services. Of course, the great hope for the Conservative party is that there will be collective amnesia at the time of the next election and that people will forget the Tory approach to public services. That now seems to be the official approach of the Conservative party. In an interview with the Financial Times last Thursday, the Leader of the Opposition said that his children do not remember Margaret Thatcher at all. All I can say is that they are very fortunate. He went on to say that, as memories fade, so people's recollection of what was done fades.
	I have a message for the Conservative party: we will keep reminding people of the Thatcher legacy and the consequences for individuals, families, communities and public services. We will remind them that every indicator of economic and social failure at least doubled under the Conservatives. Crime doubled, national debt doubled, those on long-term income support doubled, long-term unemployment doubled, homelessness doubled and child poverty doubled. We will remind them that, in the early 1990s, interest rates were more than 15 per cent., inflation was more than 10 per cent., and 1 million home owners were in negative equity. We will remind them that, by 1997, numbers on the waiting lists rose by more than 400,000; about half of our 11-year-olds failed to reach expected standards in maths and English; almost 500,000 five, six and seven-year-olds were in classes of more than 30; and, of course, there was Railtrack and privatisation.
	That is a catalogue of prejudice, neglect and dogma from the Tories towards public services. Labour's commitment to public services reflects our values, principles and beliefs as a political party. Labour believes in opportunity for all our people and in social justice. Labour believes that there is such a thing as society and that we achieve far more acting collectively than we ever can in isolation. It is through collective provision delivering social justice and providing opportunity for all that, under Labour, housing waiting lists have been cut by 120,000. Under Labour, crime is down by 22 per cent. Under Labour, all four-year-olds are guaranteed a pre-school place. Under Labour, infant class sizes have been cut. Under Labour, there are 27,000 more nurses; and under Labour, Railtrack is no longer serving the interests of shareholders, but putting the travelling public first.
	Labour in power is acting in the public interest. Labour in government is delivering for our people and our country. It is on that basis that I urge the House to divide and support the amendment in the Prime Minister's name.
	Question put, That the original words stand part of the Question:—
	The House proceeded to a Division.

Mr. Speaker: I ask the Serjeant at Arms to investigate the delay in the Aye Lobby.

The House having divided: Ayes 184, Noes 322.

Question accordingly negatived.
	Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments):—
	The House divided: Ayes 315, Noes 189.

Question accordingly agreed to.
	Mr. Speaker forthwith declared the main Question, as amended, to be agreed to.
	Resolved,
	That this House welcomes the Government's commitment to investment and reform in the public services and notes the contrast with 18 years of Conservative government, typified by under-investment and botched privatisations; recognises the progress being made on raising school standards, improving safety on the railways, cutting waiting times for NHS treatment and reducing levels of crime; wishes to see the ethos of public service strengthened in the country and recognises the importance of high quality public services to the creation of a fairer society; acknowledges the important role of public servants in achieving a fairer society and the contribution made to staff morale of growing staff numbers and rising staff pay; welcomes sustained investment in health, education, police, transport and local government and other areas of public service; believes that the Prime Minister's Principles of Public Service Reform are important to maximise the benefit gained from higher levels of public service investment; further believes that where public services do well they should benefit from greater decentralisation of power and resources, lighter inspection and greater local control; further believes that where public services fail to reach acceptable standards the Government has a responsibility to provide additional support and intervention whether that provider is in the public sector or, as with Railtrack, in the private sector; and contrasts this approach with that of the Opposition which tolerates failure in the railways, has no coherent plans to raise school standards, supports charging for NHS patients and wishes to cap government spending at 35 per cent. of GDP resulting in cuts to public services of at least £50 billion.

DELEGATED LEGISLATION

Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6) (Standing Committees on Delegated Legislation),

Industrial Development

That the draft Financial Assistance for Industry (Increase of Limit) Order 2002, which was laid before this House on 8th January, be approved.—[Mr. Woolas.]
	Question agreed to.
	Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6) (Standing Committees on Delegated Legislation),

Police

That the draft Police Emblems and Flags Regulations (Northern Ireland) 2002, which were laid before this House on 9th January, be approved.—[Mr. Woolas.]
	Question agreed to.

PETITION
	 — 
	Raymonds Hill

Hugo Swire: I have the honour to present a petition on behalf of the residents of Raymonds Hill, Axminster, Devon and others, who declare that
	the junction of the A35 trunk road and the B3165 at Hunters Lodge, Raymonds Hill is especially dangerous for motorists, other road users and pedestrians; that there is a history of accidents at the junction and that there has been a spate of recent collisions; that unless urgent action is taken, further accidents will occur, resulting in injury or even death; that 2,225 residents have signed a petition calling for a roundabout to be constructed at the junction; and that safety measures to improve the junction, including the construction of a roundabout, should be put in place as a matter of urgency.
	The petitioners therefore request that the House of Commons urge the Secretary of State for Transport, Local Government and the Regions to take such action as is within his power to ensure that a roundabout is constructed at the junction.
	To lie upon the Table.

HASKINS REPORT

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Woolas.]

Eric Martlew: I am pleased to have secured this debate, although I do not think that the ballot has been particularly kind to me. I first applied in November, and my speech has therefore had to be changed somewhat.
	I want to examine the context of the Haskins report, and why it was necessary. I shall concentrate on Cumbria, because I know the area well, and especially on the outbreak of foot and mouth.
	In February 2001, the world as we know it in Cumbria was turned upside down. Services were totally disrupted, there was despair in many parts of the county, and our economy was in a serious state. By July this year the foot and mouth epidemic had started to slow down—we were getting on top of it—but well over 40 per cent. of foot and mouth cases in the United Kingdom were in Cumbria. We had to work out how we were to survive the next 12 months, and how the county's economy could be rebuilt.
	A meeting was held in July near Bassenthwaite lake, which I attended, as did my hon. Friend the Member for Workington (Tony Cunningham), at which my right hon. Friend the Prime Minister was pressed by local members of the National Farmers Union to appoint what they called a chief executive to oversee the recovery of the economy in Cumbria. I was pleased when my right hon. Friend suggested Lord Haskins for the job, as I had previously proposed him to my right hon. Friend. More importantly, I was pleased because Lord Haskins had experience as the owner of a large farm in east Yorkshire, and of leading a large, national food company. He was known for his no-nonsense approach and straight talking.
	Lord Haskins was appointed and he got on with the job. I want to place on record my thanks to him, and those of the people of Cumbria for taking on a job that was not easy. He was not paid and, at the beginning, the job interfered with his holidays. It gave him many sleepless nights, but not only did he visit Cumbria many times; he also went to the west country and to Northumbria.
	Lord Haskins produced the report in record time. He was appointed at the end of July, and the report came out in October. It identified Cumbria's short-term problems, and offered a forecast of the situation in the county over the next five years. Haskins made 12 recommendations for the short term, and the Government responded in December—again in record time, given that the report had only been published in October. The Government accepted most of Haskins recommendations, and they are now being implemented. However, I want to bring two issues to the attention of my right hon. Friend the Minister.
	The first has to do with footpaths. The Haskins report stated that all footpaths in Cumbria should be declared open by Christmas, as they are so important for the tourist industry. The good news that Cumbria is free of foot and mouth is contradicted by the bad news that nearly 10 per cent. of our footpaths remain closed. People do not understand that, and think that all the footpaths are open. However, I believe that it will be May before the final few footpaths are opened. I ask that my right hon. Friend looks at that, with a view to speeding up the reopening.
	On Saturday, I addressed the annual meeting of the Ramblers Association at a venue in the lake district. The association's members are very worried about the matter. They are also well aware that, until the foot and mouth epidemic closed all the footpaths, walkers in Cumbria and throughout the land were looked on as a bit of a nuisance. The economic effect of footpath closures has been felt in all rural areas, and especially in those sparsely populated areas where the economy depends on people who go walking. One positive thing that came out of the meeting was that the association was going to develop a closer relationship with the tourist industry, with a view to developing more rights of way.

Roy Beggs: I thank the hon. Gentleman for giving way. Will he join me in condemning P & O, which sought to exploit the foot and mouth epidemic? The right of way through Larne harbour was closed as a result of the foot and mouth restrictions. They have been lifted, but the company refuses to open the gate and restore access.

Eric Martlew: I condemn anyone who keeps a right of way closed. I am sure that my right hon. Friend the Minister will reply to that point.
	Lord Haskins said that in the short term, £40 million was required. In her statement last October, my right hon. Friend the Secretary of State referred to £24 million but hoped that more would become available. Of the original £40 million, £20 million was supposed to go to Cumbria. I checked with Cumbria business link today and understand that it has received £17 million. I hope that my right hon. Friend the Minister will find the other £3 million. Many people who applied for grants will have received them but others could lose out.
	The Government have put about £1 billion into Cumbria. If the cost of the outbreak was £2.7 billion and more than 40 per cent. of it occurred in the county, £1 billion has gone into the local economy. Much of that will be lost when farmers buy stock outside Cumbria but that £1 billion has done a great deal. From February to September, unemployment in Cumbria dropped by 1,500. I have checked with the Library and jobless figures have dropped in every area in which there was foot and mouth, including Northumbria. Money going into the local economy has stopped the county's so-called economic meltdown.
	Opposition Members said that there would be a major recession, and there was one estimate that 15,000 jobs were at risk. Fortunately, both predictions proved wrong. However, it is no consolation to people who have lost their jobs that others have not—and businesses have gone bankrupt. Some people, through no fault of their own, have not received compensation and their businesses will not survive—but the money put in by the Government will ensure a better economy next year.
	Foot and mouth had not only an economic but an emotional impact—especially on farmers. Lord Haskins said that farmers generally were fairly compensated and that some were generously compensated. However, for farming families that had bred livestock for generations and saw it destroyed in not the best of circumstances, there was an emotional price to pay. Farmers whose animals did not get the disease but whose stock could not be moved and who found themselves isolated suffered the worst economically.
	The NFU report was critical of the Government, as I can be because I refuse to defend the way in which they dealt with the disease in the first instance. The problem is that according to the NFU report, not one farmer in any part of the country was to blame for anything—not even the farmer at Heddon-on-the-Wall, in the constituency of the hon. Member for Hexham (Mr. Atkinson). The report says that everything was the fault of the Government, the vets or the agencies—which is wrong. The NFU vacillated as much with regard to vaccination as the Government did, and the report shows that it is still doing so. I hope that the NFU will hold a small-scale inquiry into lessons to be learned by its own organisation.
	Before I discuss the mid-term proposals of Lord Haskins' report, I should like to draw attention to two issues. The first is a very local issue that concerns the villagers of Great Orton, a village that became famous for all the wrong reasons. It has on its doorstep the mass animal burial ground, where 500,000 animals are buried. Those people have probably suffered more than the villagers of any village in the country. They saw the slaughter taking place. Heavy vehicles went by 24 hours a day, passing the school. The villagers saw their village on television.
	The villagers attended a meeting with an official from the Department for Environment, Food and Rural Affairs and asked for some money for a play area for the children, as partial compensation for the fact that they had had to suffer so much. Obviously, DEFRA does not have money for play areas, as I am sure my right hon. Friend will acknowledge, but will he join me today in asking that some of the money that DEFRA paid in the landfill tax for the Hespin Wood site, which has gone into the community landfill tax trust, be spent on a play area? I understand that DEFRA may have paid £20 million to dispose of beasts on that site. The county council, which owns the company, will probably make twice as much profit as it cost it to fight foot and mouth. I ask the Minister to support me in asking that the landfill tax trust in my area pay for that playground. It would be only just.
	I am glad to see my hon. Friend the Member for Workington (Tony Cunningham) in his place. The second subject that I wish to draw attention to is the problem of moving sheep around the country and identifying where they are. There has to be an identification system, whether electronic tagging of individual sheep or identification by flock. We need an office to run that system. We have a record in Cumbria of being able to carry out such tasks. In Workington we have the cattle movement centre, so if a site is to be selected to administer the movement of sheep it should be in north Cumbria.
	I shall now discuss the medium-term recommendations. There was a belief in Cumbria that, because we now had all these empty fields, this was an opportunity, although a sad one, to transform farming there. In reality, that was never going to be the case. Cumbrian farming is back in business. Farmers are starting to re-stock. Some farmers will not return to farming. We shall have bigger dairy farms and perhaps fewer sheep. As I believe Lord Haskins said, if we can change the common agricultural policy we can perhaps look at Cumbria as a test bed, but until then we shall have to go back to our bad old ways. We should have spotted that at the start.
	The Minister has agreed to the recommendation for a rural action zone in Cumbria, and the regional development agency is providing £75 million. I should have been happier if it had been a Cumbria action zone, because I am worried that some of the priorities in the county may be skewed. There is some deprivation in my constituency, in the urban area, and on the west coast. In the past year on the Furness peninsula there has been heavy industrial decline and job losses. I hope that priorities will not be skewed.
	A recent example that has nothing to do with the rural action zone concerns subsidy. The Government have given more money for rural buses; I agree with that policy totally. However, in Carlisle, Stagecoach has decided to cut the frequency of the urban service and transfer the buses to the rural area to chase the subsidy, creating a worse situation in the urban area. Of course, the reality is that the company should have put extra buses on and run the service, but they have not done so.
	The Government did not handle the foot and mouth crisis very well, and I hope that the Minister will not try to defend that today. However, the county's economy has benefited from the £1 billion that has been provided, and the predicted meltdown has not happened. We will have a problem this winter, but if businesses, especially tourism businesses, can be helped to get through the winter, many of them will survive. Again, Lord Haskins looked at what was happening and reached a realistic view. His report is excellent, and I am pleased that the Government have accepted the majority of its findings.

Alun Michael: I congratulate my hon. Friend the Member for Carlisle (Mr. Martlew) on initiating the debate. He may have had to wait some time to speak on this topic in the House, but I congratulate him on his timing—he has introduced the debate on the day on which we have received the news of foot and mouth disease-free status, which is a big boost for everyone in this country. Indeed, this is a day on which we can really concentrate on looking forwards rather than backwards. That is not only good for farming, for tourism and for all of us who want the countryside to get back to normal and make a contribution to the national economy: it is good in so far as it helps to restore a sense of confidence in the communities that have been devastated during the past year. My hon. Friend's timing is brilliant, and he has initiated a useful debate in a positive way and raised some important issues that challenge the Government and all those who wish to see the economy recover.
	I also pay tribute to my hon. Friend the Member for Workington (Tony Cunningham), to whom my hon. Friend the Member for Carlisle referred. Both my hon. Friends have been assiduous in ensuring that the Government have not overlooked the needs not only of their constituencies but of the whole area in recent months.
	I join my hon. Friend the Member for Carlisle in paying tribute to Lord Haskins, and I have the same view of the contribution that he has made. Lord Haskins has a capacity to challenge, to entertain and to apply common sense and experience in a practical way. It is fair to say that, on occasions, he challenged in a way that sparked vigorous debate, but it shows the character of the man that he did so without giving offence. He woke people up and made them respond to challenges, but, as my hon. Friend has said, it was clear from talking to people in Cumbria—I did so myself—after Lord Haskins had reported, that they had taken to heart the things that he said and did not feel hurt by or take offence at opinions that perhaps they did not share locally. That is a practical approach.
	As my hon. Friend the Member for Carlisle said, the report applied primarily to those in Cumbria to whose request for someone to have such a role Lord Haskins's appointment was a response. However, Lord Haskins also looked for parallels with Devon, the north-east and the other parts of the country that had been affected.
	The report was published on the same day in October as the report of the rural taskforce, which I have chaired since the election. That, too, made a significant contribution because there were so many stakeholders right across the piece—people involved in farming, local government and the tourism industry and people directly involved in Cumbria and Devon made a significant contribution to its work.
	As my hon. Friend said, we made a formal response in December and at the same time considered the way in which the rural White Paper had been implemented in England in the previous 12 months. The document "England's Rural Future" demonstrates that an awful lot of work had been done even when everyone was focused on the job of eradicating foot and mouth disease. In many ways, the agenda of bringing the issue of the response to foot and mouth disease together with that of the implementation of the rural White Paper received support from a whole range of organisations. The document also demonstrates that the Government have sought to bring people together and unify them behind a sense of purpose in dealing with the countryside, which had been neglected for many years.
	The response given in December built on the immediate response that was made by my right hon. Friend the Secretary of State for Environment, Food and Rural Affairs in announcing an additional £24 million for the business recovery fund. That figure has gone up a bit in the meantime as we have announced a further £2 million in match funding for the voluntary sector scheme that has assisted with the stress and media problems that many people have experienced.
	My hon. Friend made a specific suggestion about the landfill tax. He is right to suggest that we consider how the streams of funding that are available can contribute to the restoration of the local economy. I am not able to comment on his specific suggestion, but I will consider it and write to him. Specific requirements are involved in using such streams of funding, but the question is whether the funding available for a variety of purposes can be targeted at the place where it is most needed. None the less, my hon. Friend is right given our priorities at present.
	My hon. Friend also referred to the importance of reform of the common agricultural policy. People increasingly recognise that that is necessary, and it would be good for everyone if reform happened sooner rather than later.
	I pay tribute to the way in which people in Cumbria have united to look to the future. The members of the taskforce whom I met last week were joined by representatives of the regional development agency. That is an important partnership because we channelled resources to help the recovery of the economy through the RDAs. The members of the taskforce also brought with them representatives of the taskforces led by Cheshire and Lancashire county councils, and that demonstrates that people in Cumbria are looking out from their concerns to the wider needs of the region. It is easier to be sympathetic to people's arguments when one sees them working together with other organisations in that way.
	My hon. Friend rightly said that I have expressed our support for the rural action zone. I can respond positively to his point on that, because it would be wrong to skew finances away from the social needs of the deprived areas and more needy urban areas to which he referred. It is more a question of using the resources that are available and directing them to where they are needed. We can also help to build strength by uniting different strands of finance and by local authorities, RDAs and central Government working together.
	Often, money is available for a whole range of purposes—such as through the England rural development programme and the RDAs—but it is not used to best effect unless people have access to those funds. Very often the people who most need help—both farmers and non-farmers—are in the weakest position when it comes to identifying the right strand of finance to help their business.
	On access, the hon. Member for East Antrim (Mr. Beggs) asked a question about P & 0. I am not familiar with the circumstances, and I do not wish to take time from addressing the problems of Cumbria. However, if he wishes to draw the facts to my attention, I will be pleased to consider the matter and respond as appropriate.
	My hon. Friend the Member for Carlisle rightly said that 10 per cent. of footpaths are closed. Like any quantification, the figure can be looked at either as 10 per cent. closed or as 90 per cent. open. Progress is being made on that. Although 10 per cent.—some 755 footpaths—of the network remains closed, arrangements are in place to open 438 of those over the next two weeks. By 1 February, only 317 footpaths should be still closed, which is 4 per cent. of the total network. So 96 per cent. of the network should be open by then.
	There is a difficult issue to address. Remaining footpaths will be reopened as restrictions are lifted, but if farmers choose not to use sentinel animals prior to restocking at the end of January, the last footpaths should be reopened after the requisite fallow period of four months, which is towards the end of May. In the meantime, if it is possible to identify that a farm is significantly blocking the network—obviously, some footpaths are more important than others—we need to consider ways of diverting footpaths, on a voluntary basis, in the short term.
	Although that has to be achieved by agreement, the problem was raised when I met the taskforce last week. I suggested that Cumbria should consider the details on that with officials from the Department for Environment, Food and Rural Affairs, concentrating in particular on footpaths that have a significance for wider access or if they block access to a specific part of the network. Although that is detailed, there was a positive response in the discussion and my Department will try to help if it can.
	In conjunction with all those who are concerned about access to the countryside—this is not a top-down approach by the Government—we are also developing a campaign with the message, "It's your countryside; you're welcome in it," to reconnect in particular with urban dwellers. We want people to have opportunities to enjoy the benefits of the countryside by staying in it. That also contributes to the economy, which is significant not just for the lake district but for the towns around it, because there is an interdependence of town and country. We need to emphasise that and relearn it.
	I am pleased at the positive response from those people who have agreed to be partners in that campaign. We have worked closely with my hon. Friend the Minister for Tourism, Film and Broadcasting. The Countryside Agency has joined DEFRA in providing resources and has seconded a senior member of staff who is involved in helping to co-ordinate and press that campaign forward. In the course of the next week or so, we will promote that campaign. The Government are not acting on their own; we are supporting and working with those who want to make our tourism industry a success by making the most of access to the countryside. That gives confidence back to rural communities and businesses, whether they be farmers, involved in tourism or, in some case, both—
	The motion having been made after Ten o'clock, and the debate having continued for half an hour, Mr. Speaker adjourned the House without Question put, pursuant to the Standing Order.
	Adjourned at three minutes past Eleven o'clock.